Inspection on 08/11/07 for Ross Wyld Nursing Home

This inspection was carried out on 8th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Ross Wyld Nursing Home 06/04/09

Ross Wyld Nursing Home 15/01/09

Ross Wyld Nursing Home 23/04/08

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 Michael Williams Unannounced Inspection 8th November 2007 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ross Wyld Nursing Home DS0000025960.V354140.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.V354140.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.wld@fsch.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.V354140.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. 16th April 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 service users. 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. The home is close to shops, transport networks and other local amenities. Fee as at November 2007 were £500 to £736. Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Because this was a care home previously found to be failing to achieve adequate standards it was inspected for a second time in 2007. During this 2nd unannounced inspection, in November 2007, the home was represented by a regional manager and an operations manager, the temporary acting manager was not present on this day. The Registered manager has been suspended from her duties and has since moved onto sick leave and will therefore play no part in the running of the home until re-instated. The inspection, undertaken by two inspectors from the Commission’s Croydon Office, commenced midmorning and lasted until about 7 pm. As part of this inspection we circulated questionnaires to interested parties including residents, visitors and visiting professionals. We met with as many residents as we were able to and spoke to a number of staff and visitors and we thank them for their contributions. We also took note of information supplied to the Commission throughout 2007. What the service does well: What has improved since the last inspection? What they could do better: This is a large and rather old-fashioned care home. The front entrance is not clearly defined and welcoming; the boundaries of the premises are not well defined and protected; the home has no private enclosed and protected garden area for residents. The reception area is also poorly defined and as one complainant indicated there is no reception point or person specifically designated to check who is coming and going or to deal with enquiries and deliveries. Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 6 Internally whilst there has been some refurbishment there is still much to criticise; The ground floor lounge is very large and has the appearance of a works canteen – this probably because there is a glass partition between lounge and kitchen. In a home providing care for people with physical disabilities we were surprised to find that none of the bathrooms have an ‘adapted’ bath – although the home does have hoists to assist in moving residents. We noted damage to the fabric of the building throughout including areas, such as the top floor, that have been recently refurbished. This included damage to walls and door frames; missing handles on windows; loose and broken fittings that were unsightly such as a toilet seat and bath panels and door handles; untidy areas where items such as a bed headboard and small items of clothing were left about. There were more serious and hazardous points such as the poorly organised clinic room, with two drawers full of clutter including prescribed creams and ointments, a dirty fridge used to store medication and the carpet was rucked. In a bathroom we noted that a standard light bulb was in place (on the ceiling) where one might expect an enclosed fitting in this area. Fire escape routes in several locations were being used as temporary storage areas. Fire doors were seen wedged open and in some instances the intumescent strips on the edge of the door (the smoke seal) was painted over and likely to be ineffective. There was loose wiring in a bathroom. The balcony handrail is loose and as this area forms part of an escape route should be in sound condition. There was an unpleasant malodour in one of the lounges – indicative of a long-standing hygiene issue in this area. We checked a range of records and documentation and found the formats were very good but their completion was sometimes not very informative – for example, checklists of residents’ needs with numerical ratings gives little information about the specific needs and actual condition of the person assessed. References to the new Mental Capacity Act are commendable but of doubtful value as they do not in many cases refer to any specific event or decision. Overall, we were very concerned that the wide ranging conditions of registration has led to a muddled admission policy where residents are admitted to any part of the home no matter what their condition and whether or not they are within the range of conditions agreed with the Commission. For example, frail older people needing nursing care (and who do not have dementia) were admitted to the floor providing dementia care; people with mental illness such as schizophrenia were admitted outside the agreed numbers and were being cared for in a setting designated for dementia care. There were young people expecting to make progress and be rehabilitated ready for discharge are living with much older residents who need long term care. And we note that there was no provision for people needing rehabilitation (including mentally ill and physically disabled people) such as domestic scale kitchenettes, dining areas, laundry and bathing facilities. There is a need to be much clearer about the criteria for admission, who can be admitted and to which area of the home and in what numbers. Those areas of the home then need to be adapted to meet the specific needs of residents catered for. Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 7 The Commission is taking enforcement action in relation to these matters because they compromise the wellbeing of people who use this service. A requirement is not made in this report, however if the service fails to comply with enforcement action the Commission may consider further action which may include prosecution. 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.V354140.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 Ross Wyld Nursing Home DS0000025960.V354140.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): NMS 3: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are being assessed prior to admission and can be provided with the information they need to make a decision about their admission but the home is not clear about the criteria for admission and what part of the care home and in what numbers residents may be admitted. EVIDENCE: Pre admission assessments were carried out for prospective residents both by the placing authorities and by senior staff from the home. As at the last two inspections, we found that the home uses a pro forma to carry out assessments and the level of information and detail provided was sometimes limited to numerical ratings, scores 1 to 10 and the like. The forms are very thorough and include a section on each area of need, to indicate the level of support required, and to record the persons’ usual routine and personal preference when meeting these needs. These sections had been given scores but there was often no detailed information about what there needs were, or how they were to be met. It is a repeat requirement that comprehensive pre Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 10 admission assessments are carried out for all prospective service users, to determine how the home can meet the needs of people moving into the home. In discussion with senior managers, and from our checks such as residents’ case files and speaking to staff, it was apparent that the registered manager had not been clear about prospective residents’ needs and to which part of the home they should be admitted and in what numbers. We were told of frail older people being admitted onto the dementia care unit and people with mental illness being admitted onto the dementia care unit without providing separate facilities such as their own lounge and dining areas. There appears also to have been the admission of person with learning disabilities – which is not reflected in the registration certificate. The home’s registration also limits the number of residents that can be admitted under any particular category and again this seems to have been overlooked or ignored by home. In addition to the muddle over where residents are placed within the home the issues of fees was also unclear, if residents are moving from residential to nursing or nursing to residential care then their fees should reflect this move and it was not clear from our discussions with senior managers that fees were being correctly charged or that proper assessments were being made by placing authorities before such moves were concluded. Areas of strength include the information that can be provided to prospective residents; the assessment formats are very detailed and will allow residents to make known their care needs. Matters that require attention include the need to provide more details about those care needs and how or why they have been rated or scored in the assessment forms. The home must also be a lot clearer about who is to be admitted, to which part of the home and in what numbers and at what fee level. This section about choice is assessed as adequate. Ross Wyld Nursing Home DS0000025960.V354140.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): NMS 7,8,9 and 10: Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans are detailed and kept under review. Health and social care is not being provided in compliance with registration conditions. Medication procedures are much improved but some problems as to storage of prescribed medication were identified. Residents are not being admitted into the home with due regard to where and with whom they will be living. Therefore, residents cannot be assured that they will receive the care and support they need and indicates a lack of respect for their individual needs. EVIDENCE: To assess this set of standards we read the case files relating to a sample of residents, we spoke to those residents and observed care practices, we interviewed staff and managers. We met with a few relatives 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. Care Plan folders are voluminous and contain a variety of detailed notes including assessments, care plans, risk assessments, monitoring forms and so forth. Several aspects concerned us. Assessments were often abbreviated to a numerical score without the additional detail of the issue being rated – for Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 12 example mobility or sensory impairment. We also note and commend the use of forms to record when the new Mental Capacity has been used or considered. One good example was in respect of photographs but in many instances a general and non-specific form was in place, which suggested the residents lacked capacity. This is not good practice as a decision is to be made in respect of each event, intervention or decision and staff should review capacity afresh because a resident may have capacity in one situation but not another. We also observed that not all staff were familiar with the mental health conditions of residents in their care – this was particularly apparent in respect of mental illness where staff had no clear understanding of mental illnesses such as schizophrenia even though the care plans referred to specific symptoms that needed to be monitored such as hallucinations. We were advised that there was support from Community Psychiatric Nurses (CPNs) for those residents who have enduring and active mental illnesses. By contrast some staff were very well informed about the residents, their care needs, their personal history and their family circumstances and this was particularly noteworthy and commendable. Such staff also demonstrated a very caring and thoughtful approach to residents – again very good practice. We note that professional health care support is provided including Community Nurses to support residents on the top floor (which is not registered to provide Nursing care on site); doctors visit regularly as do dentists, opticians and so on. Areas of strength include detailed the care notes and care planning; some very good aspects of care. Problems include lack of clarity about where residents are located in the home and some staff lacked knowledge about the residents they cared for. People with mental health problems are not being properly catered for. This section about health and social care is assessed as poor. Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 13 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): NMS 12 to 15: Quality in this outcome area poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured they will enjoy a lifestyle or receive the support they should expect because placements in this home are confused and inconsistent. Contact with family and friends is not inhibited except by the unpleasant malodour in some areas and because some residents are ‘out of place’. Meals are not well presented and catering standards not good. Residents do not have as much choice and control over their lives as they might expect. EVIDENCE: Because residents are cared for in an unplanned way, that is some nursing cases on the residential floor, mentally ill people in the dementia care unit and so on it was quickly apparent that the home cannot and is not providing support for daily living activities. The home employs an activity coordinator who works with two or three residents at time. But as an example residents with schizophrenia were getting much the same support as people who are losing their mental faculties; there was no recognition that a mentally ill person may well be able to lead a more active lifestyle and might still be involved in rehabilitation – skills for daily living such as shopping, cooking, education classes, and even employment. By contrast the home also caters for Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 14 residents with physical disabilities and again there was little scope for rehabilitation. The home does welcome visitors and there is no prohibition on family and friends visiting residents. We did not identify any specific visitors’ room but the home is spacious and some rooms such as the dining was seen to be empty when we visited. Staff who work closely with the residents knew about the residents’ family contacts, who visits and who keeps in touch by other means. As we were on site most of the day we had the opportunity to check the midday meal. There was a choice of pork chop with sprouts and potato or baked jacket potato with beans. The meat was tender but not especially flavoursome and the vegetables very soft indeed whilst the jacket potato was more suited to an evening snack. When we checked the kitchen the cook had gone off duty but the evening cook was on site. She told us that she does not prepare hot cooked meals other than snack-type meals and was not familiar with kitchen records or the location of the thermometer probe. The hot temperature records were suspiciously constant at 80oC every day no matter what meat or meal was being cooked. The cold storage records (fridge and freezer) temperatures were similarly constant and suggested only the unit’s inbuilt thermometer was recorded not the contents. We drew this matter to the attention of the managers for them to monitor as it seemed improbable and possibly fraudulent. We also note that the meal provided was not as listed on the menu offered to residents. We also note that one residents was a practising Muslim and apparently feels obliged to have her family bring in suitably prepared meals in addition to what the home provides. Areas of strength include the relaxed atmosphere of the home; such activities as we saw underway, board game and painting were acceptable; visitors are welcomed in this home and there is some choice about meals. Matters that need attention include a review of daily life in this home to check that each resident is afforded the opportunity lead as fulfilling a lifestyle as they wish and can achieve. This is likely to include more professional input by Occupational Therapists and Psychiatric Nurses to ensure suitable rehabilitation is provided where appropriate. Catering including meals needs to be reviewed in line with the government’s drive towards safer kitchen standards ‘Safer Food: Better Business’, and this includes a more appetising range of midday meals to suite the tastes of the wide range of persons living in this home. Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 15 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): NMS 16 and 18: Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. We are satisfied that residents are protected by the home’s procedures to deal with complaints and ‘safeguarding’ issues. Residents can be assured that the risk of abuse has been reduced because all staff have undertaken appropriate training in the protection of vulnerable adults and the procedures to follow when abuse is suspected. EVIDENCE: 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 Residents’ Guide. The home also has a complaints log, this evidenced that complaints received have been appropriately recorded and investigated. The home has a copy of the Local Authorities adult protection, ‘safeguarding’ procedures, and also its own policy on adult protection. We note from previous inspections that this is in line with current legislation. The manager informed the inspector that all staff employed at the home have received training in adult protection issues. The Commission, as well as other agencies, has received a number of complaints about Ross Wyld Lodge in 2007. These complaints outline a number of care practice issues, problems with the environment and issues relating to the management of the home. During the course of our site visit in November 2007 we were able to inquiry into many of the areas of concern and a number of matters have been identified as requiring improvement and they are listed at the end of this report. Senior managers of the organisation, Four Seasons, Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 16 recognise already that there needs to be improvements in Ross Wyld Lodge and have intensified their monitoring of this care home. From this we can judge that the company is listening to residents’ concerns and acting upon them. The Commission will require Four Seasons to draw up an action plan explaining how they intend to improve standards and meet requirements. Areas of strength include the documentation to support the complaints and protection procedures. The complaints that have arisen are being, or will be addressed by the home. Issues of concern that the Commission has observed and that require attention have been identified under other headings in this report so this section about the complaints process is assessed as good. Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 17 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): NMS 19 20 22 26: Quality in this outcome area poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured that they are living in clean, safe and comfortable care home that is suitably adapted to their collective and individual needs. EVIDENCE: This home is situated in the Walthamstow area of the London Borough of Waltham Forest, 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. Whilst we noted that some redecorating work was being carried out, there is still a lot to do. Throughout the home there are areas that need attention; either matters of décor or more substantial issues such as the boundary fence to the premises and suitable equipment and facilities to enable rehabilitation of residents intending to move on. As one approaches the building it has the appearance of an old ‘council’ built unit typical of the 1960/70s. Whilst there is a very large sign signalling the home’s presence the entrance is rather poor – indeed it was not obvious to the inspectors that the front door was indeed the front door – there was no Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 18 welcoming sign, no seating, and no entrance lobby for visitors and no designated person to meet and greet visitors who might need assistance. A camera/phone entry system and a reception window in the administrator’s office might help improve matters here. A canopy outside and better signage would assist new visitors to the home. We understand that there is certain amount of vandalism in the area, the burnt fence being an example, but the boundaries of the home are not well defined nor well maintained and in the opinion of the inspectors tends to encourage rather than discourage anti-social behaviour in the vicinity of the home. It is most regrettable that the residents have no private, enclosed garden space. It is recommended that the large car park (which is poorly maintained and was being used by local workmen as a public car park) is landscaped and part of it enclosed to give some outside space that is safe for residents to enjoy some fresh air and flowers. There is a first floor balcony at one end of the building but this is unusable because the railings are loose. As this is a fire escape route it must be dealt with to make it safe for residents and staff. It could then serve as nice outside seating area if properly presented. Internally, we were surprised to find as we toured the premises that despite catering for people with physical disabilities the home has no adapted baths/bathrooms. For example no overhead hoists and no baths specifically designed for people with mobility problems, (although we note the home has hoists that can be used in bathrooms). One member of staff said it would be helpful to have ‘stand-up’ hoist to help manoeuvre residents. There was no equipment that can be used by Occupational Therapists or staff for rehabilitation work with residents. Instead we found shower-rooms, bathrooms and toilets that were poorly presented and one at least out of use. We also note that some areas have been recently redecorated such as the dining room. It still looks fresh and clean. The large lounge on the ground floor however looks rather institutional because there is a glass panel opening onto the kitchen. This does not seem to be a necessary feature and gives a poor impression, no-one would wish to sit in the lounge and be overlooked by staff working in the kitchen - looks like works canteen. It would appear that residents are being admitted to any part of the home that has a vacant bed without due regard to the facilities and adaptations available, or not available, in each area of the home (and without due regard to the registration of the home in so far as not all areas are the home are designated as providing nursing care). This is compounded by the fact that each area of the care home has not been built with particular group of residents’ needs in mind – for example people with mental illness might expect domestic scale lounge/dining, kitchen, laundry and bathing facilities so that rehabilitation can take place and increase independence. The home has at least one residents with learning disabilities and so a small domestic scale unit is also indicated. Similarly, if person with physical disability is admitted and expected to make progress then similar facilities should be available in addition to equipment to be used to aid physical recovery. For people with dementia the design and layout of the premises can optimise their failing mental faculties. With the agreement of the Commission the Home did not have the premises assessed Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 19 by an expert such as an Occupational Therapist but we re-instate this requirement and require that much greater attention is given to optimising these old premises to make them better suited to the categories of residents the organisation has chosen to care for. A number of environmental matters require, or are recommended, for action and they are listed here:Exterior boundaries, fences burnt and broken and lack gates to the car park and poor car park surface. Lack private garden space for residents. Entrance area needs improvement. Interior: We note that the first bedroom is not protected from the lobby area by a second fire door, to give ‘two door fire protection’, as one might expect. Other fire safety matters we noted included the use of wedges such as that holding open the activities room door. There were items of furniture and tools on fire escape routes. Loose railing on balcony escape route. Magnetic door release mechanisms were not always operating properly, for example near door number 27. It was drawn to our attention that in place of a second bed sheet empty duvet covers were being used; we checked and found this to be the case. When we invited staff to correct this they produced a sheet with holes in it – so bed linen needs to be checked for quality and quantity. The lounge looks institutional. Shower room has no curtain and dirty grout and peeling paint. Loose wiring hanging from ceiling. In visitor’s toilet a loose toilet seat. In another sink adjacent to toilet the whole (pink coloured) area very poor with peeling and mouldy paintwork. In a bathroom, inappropriate light fitting (an exposed light bulb). An extractor fan not working. One shower room not is use because of leaking water. Shower room dirty. Clinic room used by nurses very poorly organised including two drawers with ointments amongst a clutter of odds and ends. Dirty carpet in room No. 22. Green bathroom poor quality fittings around bath. Shower-head hanging in a bath (and very close to a toilet) indicates this home may not have been assessed to confirm compliance with Water Regulations. In various locations handles were missing from windows. A door in the service area, near the kitchen had been severely damaged around the locks and needs replacing. There was mould on the floor near the laundry’s detergent/disinfecting equipment. Whilst most of the home was smell free and fresh one of the lounges on the top floor had offensive malodour – the company was aware of this and plans to make changes to the floor covering – this needs to be expedited. Areas of strength include the work underway to improve the environment otherwise there are great many things that need to be addressed to make this a safe and suitable home for residents and their visitors. This section about the environment is assessed as poor. Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27 to 30: Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to staff recruitment, staff training so that residents can feel more confident their needs will be met a staff team that is adequate in numbers and for the most part has the necessary skills. EVIDENCE: As staff recruitment, staffing levels and staff training were examined in detail earlier this year we confirmed there have been no substantive changes since April 2007 when we were told that the home provides 24-hour support including an emergency on-call procedure and waking night staff. There was a staffing rota, that accurately reflected the staffing indicates who is in charge of the home at any given time. The home had policies in place on recruitment and selection and equal opportunities. The inspector checked several staff employment files at random, these contained all required documentation, including CRB checks and proof of ID. At that time the inspector was informed that over 50 of the care staff employed at the home have a relevant care or nursing qualification. All staff undertake a structured induction programme. Staff have recently had training in dementia and food hygiene. However, not all staff had the necessary health and safety training, such as moving and handling and fire safety. Following a repeated requirement that all staff undertake all necessary statutory health and safety training as appropriate this has now taken place including training in aspect of residents safety often referred to as ‘POVA’ training or the ‘protection of vulnerable adults from abuse’. Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 21 Despite these improvements one of the consequences of moving residents, and sometimes staff, from floor to floor is that staff do not always know about the care needs and conditions of those they are caring for. For example when we interviewed carers they were not familiar with the symptoms of schizophrenia even though the care plans draw attention to behaviour described in the plan as “hallucinations”. Without some understanding of the signs and symptoms of this and other forms of mental illnesses they cannot be expected to observe and respond appropriately to residents’ behaviour. In practice residents with mental health problems were being cared for within exactly the same setting as those with dementia and the support provide to the two groups of residents differed little from what we saw. Although the home employs an ‘activities person’ there seems little scope for her to encourage or enable residents in any group to retain or gain independence. We noted as we interviewed a range of staff the some were very skilled, well informed and obviously very motivated. Some were less so and felt perhaps out of their depth in some matters such as mental health issues. We observed a number of points around the building that needed attention, including a poorly organised clinic room and dirty, smelly areas in some locations and damage in many areas; it is disappointing to see that staff seem not to notice, take some initiative and press for improvements in standards in the home. Areas of strength include the updated training for staff and the achievement of 50 staff qualified. Further training and perhaps specialisation is needed in some areas such as learning disabilities and mental health. Staff may also benefit from training in rehabilitation skills since there seemed little evidence of it during our visit. This section about staffing is assessed as adequate. Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 32, 33, 37 and 38: Quality in this outcome area poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured that the home has been well managed, by the onsite manager or the company, nor that it has been run in their best interests since there are so many adverse findings when we visit this home. EVIDENCE: At the time of inspection the manager had been suspended by Four Seasons, and so the manager remains absent on sick leave; this leaves a temporary acting manger to run the home. As we indicated in the summary of this report, our overall finding, in addition to the poor standard of the premises, is that we were very concerned that the wide ranging conditions of registration has led to a muddled admission policy where residents are admitted to any part of the home no matter what their condition and whether or not they are within the range of conditions agreed with the Commission. For example, frail older people needing nursing care Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 23 (and who do not have dementia) were admitted to the floor providing dementia care; people with mental illness such as schizophrenia were admitted outside the agreed numbers and were being cared for in a setting designated for dementia care. There were young people expecting to make progress and be rehabilitated ready for discharge living with much older residents who need long term care. We checked a number of records during this site visit including residents case files, the statement of purpose, resident guide, visitors’ book, kitchen records, and so forth. We did not examine financial records on this occasion. Most records were being maintained in good order with minor points noted in other sections, care assessments for example but one set of records that did concern us were the kitchen records – we noted that an entire page of hot temperature checks for meals were 80oC and the cold record checks were similarly constant. The managers agreed this was unrealistic needed investigating. The Commission’s inspected in this home in April 2007 and assessed it as a poor quality service so we checked the requirements issued at that time to assess what progress if any has been made. 27 requirements were issued by the Commission in April 2007. Of these 27 points 9 we assessed as met, almost met or we are confident will be met and so are not re-stated; this includes staff training and appraisal and consulting residents as examples. 9 items are underway such as redecorating the premises. 2 items were not checked in detail on this occasion and will be restated pending the home’s confirmation they have been met in full and this includes the dating and review of the Statement of Purpose (which we checked briefly and found to be in good order although the criteria for admission could be clearer) and the need for a five-yearly check of the electrical installations. We identified a number of new points that are similar in nature to the old requirements so they are issued as new requirements where we consider the original points have been addressed. New requirements such as care planning and the detail required in addition to scores and numerical ratings. We also find that staff need the skills and training to deal with specialist groups of residents. Residents themselves need the support of specialist nurses in some instances (Community Psychiatric Nurses for example). A number of fire safety matters arise and can be consider as urgent including the removal of door wedges and securing the balcony safety barrier. Other fire safety points such as the secondary door protection (to a ground floor bedroom) are matters for the owners to consult with their local fire safety authority. The grounds would benefit by improved boundaries and garden landscaping as well an improved entrance area. We require the premises to be assessed or re-assessed by a specialist such as an Occupational Therapist. With a view to making proper provision for mobility aids; for psychiatric rehabilitation and for disability aids, adaptations and retraining equipment. There are very few points that were not met and which we consider should have been met and they include the elimination of malodour. With no registered manager in post and a wide range of critical issues to be addressed we assessed this section about management as poor. Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 1 X 1 X X X 1 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X X X 2 1 Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 25 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 OP22 Regulation 23 Requirement The registered person must 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 service users. This requirement was withdrawn from the previous report but is now re-instated following re-inspection November 2007. Timescale for action 28/02/08 2. OP10 12 The registered person must 31/12/07 ensure that all service users bedrooms are fitted with suitable locks, and service users provided with a key unless a completed risk assessment indicates otherwise. This must be recorded in the individual plan of care detailing the reasons why. (Timescales 30/11/06 and 3/1/07/07 not met but as work DS0000025960.V354140.R01.S.doc Version 5.2 Page 26 Ross Wyld Nursing Home is underway the timescale is further extended). 3. OP19 23 30/12/07 The registered person must ensure that all parts of the care home are kept in a good state of repair and reasonably decorated. Minor works such as painting and decoration must be addressed without further delay. A detailed list of repairs is given in the section on environmental standards. (Timescale 30/11/06 not met but as work is underway this timescale is extended). The registered person must ensure that all bedrooms contain adequate furniture, and that this furniture is in a good state of repair. (The timescales of 30/11/06 and 31.07/07 have not been met but times is extended as work is underway.) The registered person must ensure that all bathrooms and toilets have suitable locks fitted with an override device for staff to use in an emergency. (The timescales of 30/11/06 and 31.07/07 have not been met but time to complete is extended as work is underway.) The registered person must ensure that the home’s Statement of Purpose is dated and subject to regular review. This detail was not assessed by the Commission in November 2007. The deadline is extended beyond 31/07/07 to allow changes to the details about managers. 30/12/07 4. OP24 16 5. OP21 12 30/12/07 6. OP1 6 30/12/07 Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 27 7. OP27 18 The registered person must ensure that all service users are provided with appropriate and adequate levels of care and support from suitably qualified nursing staff. This is a new requirement as residents may need the support of specialist nurses such as CPN (Community Psychiatric Nurses). The registered person must ensure that all items of discarded furniture are removed from the homes grounds. This is an ongoing issue as furniture is still being discarded. As the work is underway this timescale is further extended. (The timescales of 30/11/06 and 31.07/07 have not been met but time is extended as work is underway.) The registered person must ensure that all care plans demonstrate more clearly than numerical rating what are the identified needs of residents. The registered person must ensure that the home maintains all records accurately and up to date in line with the National Minimum Standards and the Care Homes Regulations and Schedules 1 to 4. In particular those relating to kitchen and catering. The registered person must ensure that the home has an appropriate electrical installation safety check carried out at least once every five years. This information was not checked in November 2007 by the Commission. The deadline is DS0000025960.V354140.R01.S.doc 30/12/07 8. OP20 23 30/12/07 9. OP7 14 31/01/08 10. OP37 17 30/12/07 11. OP38 13 and 23 31/12/07 Ross Wyld Nursing Home Version 5.2 Page 28 extended so the registered provider can confirm work has been completed. (Previous Timescales were 31/10/06 and 31/07/07) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ross Wyld Nursing Home DS0000025960.V354140.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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.V354140.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!