Inspection on 18/08/08 for The Wakefield Centre

This inspection was carried out on 18th August 2008.

CSCI found this care home to be providing an Good 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

The Wakefield Centre 17/09/07

The Wakefield Centre 28/11/06

The Wakefield Centre 15/05/06

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 09/11/2008.

CARE HOMES FOR OLDER PEOPLE The Wakefield Centre Ravenscourt Gardens Hammersmith London W6 0AE Lead Inspector Louise Phillips Key Unannounced Inspection 9:15am 18 and 22nd August 2008 th 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 The Wakefield Centre DS0000066841.V366903.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. The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Wakefield Centre Address Ravenscourt Gardens Hammersmith London W6 0AE 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) 020 8222 7800 020 8222 7801 carol.smit@wakefieldcentre.co.uk Ganymede Care PLC Wynne Carol Smit Care Home 102 Category(ies) of Dementia (102), Old age, not falling within any registration, with number other category (102), Physical disability (102) of places The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing- Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD Old Age, not falling within any other category - Code Dementia - Code DE 2. The maximum number of service users who can be accommodated is: 102 17th September 2007 Date of last inspection Brief Description of the Service: The Wakefield Centre provides nursing care and accommodation for 102 men and women. This includes people with dementia and younger adults with a physical disability. The home is located in a residential area of Stamford Brook, with easy access to transport links, local shops and other amenities in the Chiswick High Road. The weekly fees for the home range from £669 - £950. The Wakefield Centre DS0000066841.V366903.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 2 stars. This means the people who use this service experience good quality outcomes. This inspection took place over two days by two inspectors. Time was spent talking to nine staff and seven residents and viewing paperwork. A tour of the premises was carried out and care records were inspected. Information has been gained from the inspection record for the home, the Annual Quality Assurance Assessment (AQAA), that the manager completed and surveys received from 12 residents (some of these completed by a relative/ friend), 16 staff and 3 health/ social care professionals involved with the service. Three staff were spoken to by telephone. The responses received are referred to in the report. At the time of inspection the Registered Manager was on a period of extended leave, and the Hotel Service Manager was overseeing the management of the service. They are referred to as the manager in this report. What the service does well: What has improved since the last inspection? What they could do better: Areas where the home could be doing better are highlighted in the report and were discussed with the manager during the inspection. These include improvements to the décor, medication guidance and staff training. The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 6 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. The Wakefield Centre DS0000066841.V366903.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 The Wakefield Centre DS0000066841.V366903.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): 3 and 6 Quality in this outcome area is good. The residents are appropriately assessed prior to moving to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prospective residents to The Wakefield Centre are appropriately assessed to ensure that the service is able to meet their needs. At the start of the assessment the service receives needs assessments and care plans from the local authority and from this the home carries out its own pre-admission assessment. This information is then used to form the basis of the pre-admission care plan for the resident during their move to the home. The assessment covers all activities of daily living of the resident, including personal cleansing and dressing, their sleep pattern and their independence in mobilising. The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 9 Once the resident moves to home an assessment sheet is completed, which is more informative and individualised, including information about their social history, medication, and more information about their abilities in carrying out their activities of daily living, such as particualr cultural needs in relation to food, languages spoken and what the resident likes to wear. It was observed that more information could be included in the ‘social history’ section for some residents, as some simply said ‘married or only provided details about their family. As part of the assessment process potential residents are invited to visit the home to meet staff and residents and look at the service provided. Residents move in for an initial trial period of six weeks. Prior to the end of the six weeks a review meeting is held between the resident, their relative, social worker and manager of the home to review their stay and for the resident to decide if they want to stay. Intermediate care is provided by the home, with a physiotherapist and physiotherapy assistant employed to work with residents preparing to return to their own homes. A gym is provided to enable them to support residents with their independence. The Wakefield Centre DS0000066841.V366903.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 and 10 Quality in this outcome area is good. Residents feel they get good care, and the care planning ensures that their nursing needs are met. Improvements are needed to the medication policies to ensure that this is administered appropriately to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The responses to the surveys provide a valuable insight into the experience of residents living at The Wakefield Centre, along with the observations of their relatives. Responses from residents indicate that they feel they generally get good care and support from the care staff, though one stated that this can depend on which staff are on duty. Most residents say that the care is delivered with kindness and with respect to their privacy and dignity. The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 11 Responses from staff reflect that they care about the residents and that they are kept up-to-date about any changes to their needs. In addition, feedback from health and social care professionals involved with the service say that they feel the staff work hard and treat the residents with respect, contacting them when necessary to seek advice. One professional commented that: ..they are improving in regard to acting upon and reacting quickly and appropriately to clients who have weight loss or who are at risk regarding their skin... Other areas where professionals feel the home could improve are for staff to have a better understanding of particular individual needs and behaviours of people with dementia, and personalising care more, particularly when writing in their care files. When we asked the health and social care professionals what the home does well, they commented: ..very caring/ friendly to service users.., ..staff know their residents very well, so are better placed to respond to their needs.., ..complex needs are being managed well.., ..care staff trained well to deal with complex individual needs.. There is a full-time physiotherapist and physiotherapy assistant employed at the home, along with a part-time occupational therapist. Staff reported that an optician, tissue viability nurse, doctor and chiropodist visit the home regularly. The manager spoke about recent difficulties they have encountered with arranging dental care for the residents, but that an agreement has been made with a local dentist for them visit residents who are unable to attend the dental surgery. Where asked if they feel they get good medical support, some residents said that they would like to have some input from the physiotherapist, but the majority of residents said they are happy with the medical support they get. Prior to the inspection some care staff reported that they have to get residents up from 5 or 6am in the morning, that they have to wake them up ready for the day staff to take over their care at 8am. Part of this inspection included an early morning visit to the service, at 5:50am, where only one resident was found to be up and dressed, which they said they like to do, due to their previous job delivering milk early in the mornings. Staff on duty said that they are not told to wake residents up from 5 or 6am, and they identified three residents who like to get up early, and this was found to be recorded in their care plan. Six residents were spoken to during the inspection, and all said that they can get up when they want. During the early morning inspection one staff member was found asleep, and this was reported to the manager. The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 12 The care plans for a number of residents were looked at during the inspection. They contain individualised information such as communication needs, specific cultural or medical needs around eating and drinking, personal cleansing likes and dislikes, mobilising, and preferred times of sleeping. The care files are well-maintained, with records to demonstrate that appropriate assessments are carried out around the risks of pressure sores, nutrition, moving and handling, continence, falls and the use of wheelchair straps. Where applicable, wound care photographs have been taken to show the progress of a resident’s wound/ulcer, plus correspondence from the tissue viability nurse to demonstrate that the care given is up-to-date. Relatives have signed consent forms for the use of cot-sides where necessary. However, it was observed that there was no risk assessment or risk management plan in place regarding recent incidents that have happened at the service, and a requirement has been made to address this. Some work is needed on information about each residents social history and previous occupations, as this was observed to be blank in a number of areas, or simply saying “…he likes to listen to music…”, with no further information. Similarly, the assessment for one resident says that they have a “…keen interest in watching TV, fishing, going to pubs and socialising with friends…”. However there is no evidence of how any of these interests are facilitated. The care plans are not person centred, however they contain a lot of information and are individualised to reflect peoples healthcare needs. As stated earlier in the report, they do not contain much information on social needs or hobbies/ interests, and there is no evidence that residents are involved in planning their care. Additionally, the recording in the daily notes needs to be improved to give more of a picture of how the resident has spent their day, what they have done, food consumed and interactions they have had, as the terms currently used, “…washed and dressed…”, “…urine draining well …” and “mouth care given…” does not adequately describe this. Also, an entry in one residents care plan states that they are “...deaf and dumb..., which is an inappropriate term to use, and a requirement has been made regarding these findings. The medication on two units was checked. These were seen to be generally well managed, with the medication room locked securely and kept at constant air-conditioned temperature. The medication fridge temperature is checked daily and eye drops all had the date of opening on them. The controlled drug cupboard was locked and these are stored and recorded correctly. On one unit the Medicine Administration Record (MAR) charts are kept in two lever arch folders, and it is recommended that the service put dividers between each persons sheet to make it more organised and easier to find each The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 13 individual chart. Also, most had colour photos attached to their MAR chart, but three did not. The medicine policies and procedures available were seen not to be up-to date, where the ‘clinical services’ procedure was dated January 2004 and the ‘disguising of medication’ information was dated May 2002, and referred to the UKCC which changed some years ago to the NMC (Nursing and Midwifery Council). The BNF (British National Formulary) was dated September 2006, and a copy of the updated Royal Pharmaceutical Guidelines or CSCI guidelines for care homes was not available at the home. The home must ensure that updated information is available to ensure safe, up-to-date practice is followed by staff administering medication. The Wakefield Centre DS0000066841.V366903.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 and 15 Quality in this outcome area is good. Residents have the opportunity to be involved in activities provided by enthusiastic staff. There are a good selection of meals provided that cater to individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are two full-time activity co-ordinators who plan and provide activites at the Wakefield Centre, both of them were spoken to during the inspection. One activity co-ordinator had only been in post a week, but demonstrated a good undersatnding of the interests of some of the residents, and a great enthusiasm for her work. She said she is currently in the process of getting to know the residents on an individual basis and has been involved in someoneto-one work already with a number of them. She demonstrated that any time spent with residents, what they do and the interactions between them and her is recorded in the ‘hobbies and interests’ section of their care file. The activity co-ordinator who has worked at the home for a number of years was similarly enthusiastic about her work, saying that she starts each day by going around and greeting each resident, having a brief chat about the day, The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 15 weather and what activities will be taking place. On the day she had planned a session making plastic flowers and looking through magazines with residents. She spoke about a number of events that have recently occured at the service, including a trip to Buckingham Palace, Brighton, Kew Gardens and the homes annual summer fete. She says she asks all residents if they want to go on the outings, and their relative if they are unable to communicate. She says she trys to ensure that all residents get to attend some outings, so that it is not always the same people. She spoke about specific training that she has had in reminisence, which she uses when providing activites for residents with dementia. She also spoke about other training she has achieved, such as the NVQ in health and social care, basic food hygiene and fire safety. The activity co-ordinators work between the three floors, with one permanently on the second floor and the other splitting her day between the ground and first floor. The activity planner on display on each floor details different activities to reflect the different needs of the residents on each floor. An example is that use of the computer, and emailing is provided for the younger adults on the second floor, whereas flower arranging and ball games are provided for the older residents on the other two floors. Residents said that there are usually activities that they can get involved in, and that they enjoy the trips out. Professionals involved with the service said that they feel the home works well to meet the needs of the diverse population, with one commenting that ...some of the activities could be adapted more to individual needs.... Lunch was observed being served on one of the units in the home. The tables in the dining areas were nicely laid up, with matching tablecloths, napkins, jugs of juice and flowers on the tables. The staff were relaxed, and some were seen appropriately supporting residents to eat, engaging them in conversation whilst doing this. The menus are rotated on a four weekly basis. There is a choice of three main courses each day - fish, meat and vegetarian. Breakfast is a choice of cereals, toast or cooked breakfast and supper can be either sandwiches, pizza and salad, scampi, burger, scrambled eggs or omelette salad. Feedback from residents is that they like the meals and food provided at the home. The local authority food standards agency (environmental health) have recently awarded the home a 5 stars (excellent) rating for their kitchens. The Head Chef was spoken to during the inspection, where he spoke knowledgeably about halal and said that whether the residents are Jewish or Muslim he could provide the correct halal diet. He produced certificates to show that he has training in this area. The Head Chef reported that he visits the residents when they are admitted to the home and makes a note of their allergies, likes and dislikes. He records all dietary needs in a note book, along with any complaints. He also recently sent The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 16 out surveys to all residents but only received twelve back, though said that he has made changes to the menu in light of the responses. The Wakefield Centre DS0000066841.V366903.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 and 18 Quality in this outcome area is good. There are systems in place to minimise risks to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has a complaints procedure that is provided in the Service Users Guide and Statement of Purpose. The procedure is also displayed prominently around the home. Feedback from residents and their relatives is that they know how to make a complaint if there was something they were not happy about. Healthcare professionals involved with the home said that they generally found the responses to concerns good, where one said ..the care home staff have acted swiftly on complaints raised.... Survey responses from staff demonstrated that they have a good awareness of how to deal with a complaint should they receive this, where they feedback that they would refer to the complaint procedure and direct the complainant to more senior staff in the service. There is a file held in the managers’ office specifically for the logging of complaints, along with records of actions taken and any correspondence relating to these. The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 18 At the time of inspection most of the staff team had received recent training in abuse awareness. However, this was found to be part of a four hour course that covered a number of other areas in addition to the POVA (Protection of Vulnerable Adults) training. One staff file contains a copy of the POVA training slides, showing the content of the training received. In the section about ‘inappropriate restraint’ one of the slides says this is “…to lock up a resident for longer than is necessary...”. Then, under responsibilities it states: “…if you notice something wrong discuss it with your colleagues or manager...” and “…if you have evidence of someone abusing a service user report the matter to your manager...”. There was no reference to following local authority guidelines, or about who else staff could contact instead of the manager, eg. Safeguarding co-ordinator at local authority, or CSCI. The discloser information is similar, as one entry states: “..disclose information to your manager first and only to your manager…”. Another line states: “…never disclose information without your manager’s consent...”, again with no reference to local authority guidelines or whistle-blowing procedures. This information could potentially be confusing to staff and does not follow appropriate safeguarding procedures and policies. During the inspection some of the staff spoke about how they are encouraged by the manager to report any safeguarding issues immediately. Staff spoken to during the inspection had an understanding of what they should do should there be suspicion of abusive practice taking place. However, the response of staff to a recent incident that occurred at the home demonstrates that they need more robust training in this area. The service should seek more substantial training in abuse awareness, and is it required that appropriate training that incorporates the local authority safeguarding adults procedures is accessed to train staff. A majority of the staff have been recently trained in moving and handling, with further training planned for those who need refresher training. The Wakefield Centre DS0000066841.V366903.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, 22, 24 and 26 Quality in this outcome area is good. The environment is welcoming and relaxed. The staff help create a calm atmosphere throughout the home. The décor and furnishings are good in most areas, though some improvements are needed to make the home more comfortable for the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents at the Wakefield Centre comment that the home is fresh and clean. Staff also say that the rooms are very well kept and that there is appropriate equipment such as hoists and commodes to enable them to do their work. Care is provided on the ground, first and second floors and toilets, bathrooms, communal lounges and dining areas are situated on each floor. The residents The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 20 have access to facilities including a hair salon, physiotherapy room, internet room and there is music equipment and TV’s in the communal lounge areas. All residents have single rooms with en suite bathroom. The bedrooms were observed from the hallways only. They were seen to have a good standard of décor and furnishings, clean, tidy and personalised with photographs and other mementoes of each resident. However a number of areas were noted as requiring attention, and these are listed below: - The hair salon décor looked worn and in need of decoration. This is because the wallpaper was peeling away from the walls by both windows and also around the sink area. There were loose tiles above the sink which need to be replaced. The linoleum is in need of changing as it is stained and creased and a potential trip hazard. There was also a large crack down one wall to the right of the room, and this need to be investigated and repaired. - Stained carpet was observed ouside the servery areas on each floor. - Throughout many of the communal areas, particularly the hallways, we saw that the carpets were frayed in places, which looks unsightly and could potentially pose a risk to anyone walking around the home. - On the ceiling panels of the ground floor damp spots and brown stains were observed. These need to be investigated and made good. - Some staff said that the service lifts are not appropriate for use, and keep breaking down. This needs to be investigated and made good. - The walls in the lounge areas were observed to be quite bare and in need of some pictures or wall hangings. A digital clock on the wall in the lounge of the dementia care unit was felt to be inappropriate and confusing, as various information is displayed on this. The activity planners on display should be in a larger font so they are easier for the residents to read. - We also felt that there should be some distinction between the different units at the home, as they each look very similar when you enter them. Consideration should be given to making the second floor décor more reflective of the younger adults accommodated there. Similarly, the dementia care unit on the ground floor should be designed more for the dementia care needs of the residents, eg. appropriate signage for rooms, memory/ life boxes on bedroom doors, reality orientation signage, sensory boards, etc. The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. The service carried out appropriate recruitment procedures to minimise risks to residents. Staff receive training to enhance their skills and knowledge for working with residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Wakefield Centre has a consistent staff team, some whom have worked at the home for a number of years, and who have a good understanding of the needs of the residents. The acting Clinical Nurse Manager said that the home has no staff vacancies and that the staffing levels for morning shifts are: 2 nurses and 5 care staff on the ground floor, 2 nurses and 5 care staff on the first floor and 2 nurses and 6 care staff on the second floor. He said that on each floor during the night there is 1 nurse and 3 care staff. He also informed us that the managers for each unit are not supernumerary, and are counted as part of the nursing staff numbers on shift. Feedback from one member of staff is that they feel there are sufficient staff on each shift. However, a majority of the responses from staff is that they only sometimes feel there are enough people to meet the needs of the residents. Some comments received from staff regarding this issue are: The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 22 …there are times when I work we are short of staff..., ...I think that one extra staff on shift would help to provide better care..., ...it is usually 7 service users for each care worker, by the time they finish their breakfast at 10:00am you only have two hours to have all the seven cleaned/ bathed and in the lounge, without forgetting to make their beds..., ...we have three carers at night and one nurse on a floor with 35 residents..., ...sometimes when one staff is sick no replacement is provided...often three staff to care for 35 residents on each floor.... ...they should employ more care workers because of the big workload..., ...nurse and care workers should work as a team, as the nurses do not respond to the call bells.... Feedback from residents is generally positive, where they say that the staff are caring, kind and respectful of their privacy, however they do say that they often feel the home is short staffed, and sometimes have to wait a while for a nurse or care staff to attend to them. Similarly, some relatives said that there are never any staff around, and that they have to wait a long time for someone to be free to attend to their relative. One said that “…staff always seem too busy to spend any quality time with residents…”. Another comment received was: …most of time residents are left alone in lounge, and no-one is there to monitor their movement or offer a drink...I always have a hard time time trying to locate staff.... The service should consider increasing the number of care staff on each shift to ensure that there are sufficient numbers to meet all the needs of the residents. The home holds recruitment information on each member of staff. The staff files are well organised and contain relevant information such as proof of identification, correspondence relating to offer of job, Criminal Records Bureau check, two references and record of the interview of staff. Some files do not contain a colour photo of the staff member, it was also observed that some of the ‘terms and conditions of employment’ had been signed by the staff member only, and not a manager within the company. Staff said that they felt their recruitment was fair, with one saying that the team are diversely balanced regarding different races, religions and a balanced gender mix. However, one staff member did say that sometimes staff speak to each other in their native language during working hours, making them feel left out. It was observed in the file of a staff member who is employed on a student visa (doing an NVQ course) that they had signed the form to say they were opting out of the Working Time Regulations, enabling them to work well over the 20 hours limit allowed by the student visa. The rota for the previous four The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 23 weeks for this person shows that they worked between 36 and 72 hours per week. The manager produced evidence to demonstrate that students are allowed to work full-time during vacations from their studies. Further evidence supplied shows that the students’ college holidays are for the month of August. However, the four weeks rotas seen date back to the week commencing 20th July 2008, where the employee worked 36 hours the first week, 72 hours the second week, 60 hours the third week and 54 hours the fourth week. The CSCI have contacted the Home Office to seek their advice on this issue, and a response had not yet been received at the time of writing the draft report. It is anticipated a response will be received prior to the publication of the final report, where advice provided will inform the findings from the inspection, and amendments made where necessary. All new staff receive an induction to the service which covers areas such as the service policies, health and safety, moving and handling and introduction to the staff and residents. Staff who responded to the survey gave mixed reactions about their induction, with some saying that it helped them learn a lot about the job, whereas others said that it should be for a longer period than one day, where others said theirs lasted one week. The staff said that they get enough training to support them in their role, and that they have the right experience and knowledge to meet the residents needs. With one commenting that: …its very good, I have learnt lots of things which help me to provide better care..., with another saying ..I have done my NVQ level 3, and also various training to help me.... One healthcare professional stated that: …staff appear to have the basic skills required.... Training records indicate that staff have training in first aid, risk assessment, infection control, fire safety, basic food hygiene, and heath and safety. A number of care staff have achieved their NVQ level 2 in Care. Of the records seen for staff working on the dementia care unit, only some have received training in dementia care, and it is required that all staff working on thie unit received this to ensure they understand the needs of the residents. As identified earlier in the report, staff should receive training in personcentred planning to enhance the care planning and needs of the residents. Additionally, more robust training in safeguarding adults must be sought. The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is good. Policies, procedures and checks carried out at the service promote the helath and safety of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The previous inspection found that the Registered Manager had the necessary experience and qualifications to manage the care home. Since the last inspection she has become the Registered Manager for the service. At the time of the inspection the Registered Manager was on an extended period of leave, and the Hotel Services Manager had taken the role of acting The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 25 manager. To provide support, a Unit Manager was acting up into the role of Clinical Services Manager, as this position is vacant. The surveys sent to staff indicate that some feel there is not good communication and they feel not respected and unsupported in their role. These issues were fed back to the manager during the inspection process. The manager said that the home carries out quality assurance through regular audits and health and safety checks. He said they have regular meetings with staff and relatives as well as suggestion boxes around the home. Visits by the Responsible Person are carried out monthly, and a report maintained of these. The home holds a personal allowance for each resident that is funded by themselves, their family or through social services. This money is used for when a resident wants to go shopping or use the hairdresser, etc. Records are maintained of all transactions, with statements printed each month and given to the next of kin, where applicable. The management of the money is overseen by the manager of the service. The service maintains records to demonstrate that appropriate health and safety checks are carried out on the fire system and equipment, electrical installation, gas safety and Legionella testing, etc. The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 X 3 X 4 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 13(2)(c) Requirement The Registered Person must ensure that risk assessments and risk management plans are in place to reduce any unnecessary risks to residents. The Registered Person must ensure that appropriate records about residents are maintained. The Registered Person must ensure that up-to-date guidance, policies and procedures regarding the safe administration of medication are in use at the home. The Registered Persons must ensure all staff receive robust training in safeguarding adults, that includes the procedures and policies of the local authority. The Registered Persons must ensure that the home is of sound construction and kept in a good state of repair, and that all parts are kept clean and reasonably decorated. (Please refer to list on page 21 of this report). The Registered Person must ensure that staff receive training DS0000066841.V366903.R01.S.doc Timescale for action 30/09/08 2. 3. OP7 & OP37 OP9 17, Schedule 3 13(2) 30/09/08 30/09/08 4. OP18 OP30 13(6) 31/12/08 5. OP19 OP26 23(2)(b) 31/12/08 6. OP30 18(1)(c) 31/12/08 The Wakefield Centre Version 5.2 Page 28 appropriate to the work they are to perform, particularly those working with people with dementia, to ensure their needs are met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP7 OP20 OP27 Good Practice Recommendations The Registered Persons should ensure that residents are involved in planning their care, and that this is demonstrated. The service should adopt a person-centred planning approach to care, and provide staff with training in this area. Consideration should be given to making the décor in each unit of the home more reflective of the different residents accommodated on each. Consideration should be given to increasing the number of care staff on each shift to ensure that there are sufficient numbers of to meet the needs of the residents. The Wakefield Centre DS0000066841.V366903.R01.S.doc Version 5.2 Page 29 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 The Wakefield Centre DS0000066841.V366903.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. 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