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Inspection on 06/06/06 for The Warren

Also see our care home review for The Warren for more information

This inspection was carried out on 6th June 2006.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

This Home welcomes all people with enthusiasm that shows not only in the approach to visitors, but the welcoming environment on entering the Home. The Manager and staff team work hard to include the community into the Home. The Home ensures the bedrooms are personalised and within the new extension have included door-knockers and letter boxes to each bedroom door to make the ownership of that room even more personal.The Home has a variety of activities that many enjoy that is run by a designated staff member that does not encroach on care staff tasks.

What has improved since the last inspection?

The medication records are more accurate which was a requirement on the last inspection. The Home now has installed washing machines that are suitable to cope with the amount of washing required. The new extension with larger rooms and en-suite showers has enhanced the building and facilities. The Home has introduced a diary record for each resident that gives a daily picture in the life of the resident as well as the care offered written separately on the daily records.

What the care home could do better:

The Home needs to look at ways of offering the meals in the dining room to promote independence by placing liquids in jugs for self-pouring and vegetables in dishes for people to serve themselves. The Home needs to revisit the medication administration procedure and ensure it is followed by all staff. Although the home does have quality audits each month the Home needs to collate all this information annually and use it to improve/develop the service in the following year and share this information with all interested parties.

CARE HOMES FOR OLDER PEOPLE The Warren 157a Wroxham Road Sprowston Norwich Norfolk NR7 8AF Lead Inspector Ruth Hannent Unannounced Inspection 6th June 2006 09:30 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 The Warren DS0000067710.V299143.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 Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Warren Address 157a Wroxham Road Sprowston Norwich Norfolk NR7 8AF 01603 426170 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) www.barchester.com/oulton Barchester Healthcare Homes Limited Mrs Carol Norton Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places The Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29/12/05 Brief Description of the Service: The Warren provides personal care for up to 44 elderly people. All of the bedrooms are single. The homes accommodation, communal areas and administrative areas are all located on the ground floor. The Home has recently extended the property to add a further thirteen bedrooms all with shower ensuite facilities. The home is located in a suburban area of Norwich. It is set back from the main road in secluded grounds. The garden extends around the building and outside seating is provided on the lawn. There are pleasant flower beds and mature trees. To the front of the home there is a large area for parking. The Warren is owned and operated by Barchester Healthcare. Email warren@barchester.com Fees £500 - £580 per week The Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that completed the information gathered over a period since the last inspection. It took place with the Manager and Deputy Manager over a period of five hours. Throughout the time since the last inspection the Home has moved forward with a new extension and new residents arriving. Although the new area has created quite a disruption the residents have been very involved in each stage and enjoyed seeing it grow as discussed with the Inspector on the site visits and at the official opening. A few requirements made at the inspection in December had been acted upon and evidence was seen during the visit. It is unusual for the commission to receive comments from health professionals prior to inspections but four were received for the Warren and excellent comments were written. Eight comment cards from residents and nine from relatives show they are all happy with the service provided. Records were looked at on the day that included care plans, medication records, training records and risk assessments. A tour of the building took place and many residents and some staff were spoken to. A recent resident was spoken to in more detail and this persons records were looked at in detail to follow the care received from start to date. A meal was taken with the residents in the newly extended dining room. What the service does well: This Home welcomes all people with enthusiasm that shows not only in the approach to visitors, but the welcoming environment on entering the Home. The Manager and staff team work hard to include the community into the Home. The Home ensures the bedrooms are personalised and within the new extension have included door-knockers and letter boxes to each bedroom door to make the ownership of that room even more personal. The Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 6 The Home has a variety of activities that many enjoy that is run by a designated staff member that does not encroach on care staff tasks. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Warren DS0000067710.V299143.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 Warren DS0000067710.V299143.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence and includes the visit to this service. The Home ensures the care can be met by carrying out an assessment, discussing the care and shows all interested parties around prior to admission. EVIDENCE: A meal was taken with the two most recent residents who were able to give clear descriptions of how they were assessed and the visits they had to both the Warren and other Homes before making the decision to make this home theirs. One comment was ‘it is more like a four star hotel than a home’ and ‘I have only been here a few days and already it feels like a start to my new life’. They both were very happy with the care they receive and stated their care needs were discussed with them before they decided to move in. The Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 The quality of this outcome area is good. This judgement has been made through available evidence and includes a visit to this service. The care plan information is good but needs to be on a more person centre format. The health care needs are met well. Although records and storage of medication is very good the administration procedure needs reviewing. Residents are treated well with privacy and dignity upheld. EVIDENCE: The residents all have a care plan that is at present locked in a cabinet within the office and is written on a format that is not easy to identify and not person centred. The information on each resident is there but due to the clinical type forms make it difficult to record or read at a glance. With documents such as The Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 10 these belonging to the residents and should be available to them at any time the format needs to be revised. According to the Manager this is being changed shortly and the residents care plans will be more easily read and available. (Recommendation). Each resident is registered with a local GP. The information on any visit is written and was seen on the visit, within the care plans. A nurse was in the building on the day of the inspection and was assisted by staff members in an appropriate manner. The four comment cards from both GP’s and Nursing Manager gave a good picture of the interaction between the Home and the surgeries. On talking to three residents all were happy with the GP service and one person who regularly sees the district nurse felt very well supported. On talking to a staff member all residents have a medication review which takes place when the GP visits. Picking one or two residents each time to ensure medication is accurate and appropriate. The medication is stored and recorded very thoroughly with records of MAR charts inspected, controlled drugs records and amount checked and each record holding a photograph, name and date of birth. The administration process that took place at lunchtime observed the responsible staff member leave the medication on the table and walk away without witnessing the swallowing of the tablet. This means the chart was signed as medication taken and yet this was not seen. (Requirement). Throughout the day through observation and from talking to residents each one felt they were treated with respect and their dignity was preserved. Doors were knocked on, whenever a resident was asked a question choice was always offered such as ‘would you like to sit here or in your bedroom’ ‘ are you warm enough or would you like the window closed’. ‘Would you like to sit in the sunshine or join in the word game in the lounge’. The Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is excellent at trying to match the lifestyle preferred by each resident. The Home actively encourages the community to be involved and relatives are made very welcome. Residents are helped to take control over their lives. Meals are wholesome and there is choice but the choice needs to be reviewed and the way the meals are served could be better. EVIDENCE: The Home works hard to ensure residents have available a lifestyle that they wish. It was noted in the daily diary sheets how involved the Home was with organising individual events for individual residents. It was noted how happy a resident was as she had led the church service, another had a key worker involved in a surprise gathering of all her family. One resident has his wine The Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 12 rack set up in his room with another holding a small fridge to entertain their family members when they visit. A new resident was set up with all her favourite CD’s to play when she wished and her room contained all possessions she holds dear. Relatives were coming and going on the day of the inspection with plenty of smiles and laughter noted. Nine of the comment cards received from families all stated they felt welcome and could visit when they wished. The Home has recently held an open day to show the community what residential care is all about. The Manager will often invite people to look around and encourages anyone who shows an interest. The residents are encouraged to manage their own affairs. The Home has worked hard to introduce advocacy to all residents. Within the entrance are leaflets and information about an advocacy service and the Manager was able to state who had made use of the service and the valuable advice received. One new resident had seen the leaflet and may be using this service in the near future. The residents spoken to all praised the meals highly in their comments to the inspector. Eight of the comment cards received prior to the inspection stated they enjoyed the meal usually or always. On the day the choice was smoked haddock or broccoli bake with mash, green beans and carrots. Dessert was bakewell tart and custard or black forest trifle. Two comments were overheard from residents who were asking where the meat and gravy was. In discussion with the Manager it is apparent that a review of the menu’s is to take place and to talk to the residents about the choices available. The residents were able to state they choice the meal the day before but do not always remember what they have chosen. It was also noted that one lady did not like carrots but they were placed on all plates as was all the vegetables and also the pouring of the custard on the tart. (Choices of what, how much or non was not evident) (Recommendation). The Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service. This Home actively encourages comments/complaints but has not received a complaint. The residents are protected from abuse. EVIDENCE: The Home has a complaints procedure but has not received a complaint and all comment cards received state they would know how to complain but have not needed to. Talking to residents they state they can always talk to the Manager but all feel very happy with all aspects of their care so do not need to complain. In the entrance the Manager has placed a general comment book for anyone who wishes to make a comment. It was also noted that many letters and cards of thanks were held in a album for all to see. Staff are trained and the dates are current (seen) on the Protection of Vulnerable Adults training. One staff member stated she would not hesitate to report on any concerns if she was at all worried about potential or actual abuse. The Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The quality of this outcome area is excellent. This judgement has been made using available evidence including a visit to the home. Residents live in a good, clean and well-maintained home with comfortable indoor and outdoor facilities. EVIDENCE: Considering this Home has been through a huge building development that has only just been completed the condition of the whole area is in very good condition. All areas are smart and tidy. The grounds and gardens are well maintained. Garden furniture is well placed and in use on the day of the inspection. All the records for health and safety are current which includes fire alarm checks and emergency lighting (seen). The building is well decorated, well furnished and very clean. The Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 15 The laundry room now holds adequate washing machines to cope with the requirements of the residents and on the day of the inspection were receiving the final check after installation. There were no unpleasant odours and all of this area was clean with all washing held in appropriate bags. The Home has designated domestic staff who were busy shampooing carpets on the day of inspection and on discussion have shampooing as a regular task. All the carpets appeared clean and odour free. The Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. The quality of this outcome is good. This judgement has been made using available evidence including a visit to this home. The residents are assisted with tasks by well-trained staff at suitable times who have been recruited appropriately and safely to ensure protection for the residents. EVIDENCE: The Manager is constantly reviewing the rotas and has identified a pattern of care that means more staff are required at certain times of the day and less when the needs of residents lessen. The rota’s were sent prior to the inspection and appeared to be adequate. It was also noted on the day on the inspection that staff were available and assisting appropriately and timely to residents. When discussed with residents the support they receive from staff they all felt the care was timely and appropriate. One person told the inspector he has developed his skills by moving rooms to being more independent in the shower but staff are available at the time he requires to ensure he manages safely. There are plenty of domestic staff and catering staff with a designated person for activities. The staff team have moved forward with gaining qualifications since the last inspection with more staff aiming towards their NVQ 2 award. This will make a total of nineteen staff with an NVQ qualification. The Home has a new assessor The Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 17 and is about to send another staff member to gain the assessors award. The assistant Manager is also aiming for the NVQ 4. with assignments waiting to be signed off. Although the personnel records were not looked at on this occasion they had been seen clearly at the December inspection with all records in place and CRB’s gained. A new staff member about to be recruited was having problems with gathering all the required ID documents for the CRB as she does not drive and does not hold a passport. This was discussed during the inspection and the CRB web site is to be looked at by the Manager for further advice. The Manager was fully aware that staff cannot be left unsupervised until that CRB is received. The Manager has very clear records of who has received what training. The Barchester manual for inducting all new care staff is at present used and is the process that complies with induction standards. This document was looked at and on talking to staff they feel all areas of induction, development and training is very good within the company. The recently installed training computer is about to be placed in a more accessible area and has programmes that include statutory training which will give access to staff more easily. (It was noted that staff also receive information on new policies and sign to say they have read them. A copy of the ‘Diversity’ policy was in the staff area on the day of the inspection). The Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 The quality of this outcome area is good. This judgement has been made using available evidence including a visit to the Home. The registered person shows excellent skills as a Manager who leads well and works with a good ethos and is constantly forward thinking. The Home needs to develop further the way they collate quality assurance information to share with interested parties and aid the development plans for the future to prove the home is run in the best interests of the residents. Resident’s financial interests are safeguarded. The manager ensures the health, safety and welfare of all staff and residents is protected and promoted. EVIDENCE: The Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 19 The Manager of this Home is a competent, enthusiastic and trained Manager who has been in most for a few years. The change and development of the service with the new extension has been taken on board with keenness and a determination to develop the service and move with the needs of residents. The Home has an internal quality assurance procedure that will assess certain parts of the service each month. The collating of all the evidence and producing a document for all interested parties is yet to be produced and although it has been discussed with the Barchester company a quality assurance system to measure aims and objectives that are in line with the statement of purpose for the Home is not yet in place. (Requirement) All the resident’s money is either managed by themselves or by the family. The home does not hold any money but will assist people to the bank to collect what they wish. (This is happening with one resident’s at present, who was spoken to by the inspector and is happy with this arrangement). Bills for items such as chiropody or paper bills are sent by the home if not paid for directly. The Manager holds records of health and safety checks carried out within the Home including hoist servicing and fire equipment servicing.(seen) The home staff, all attend statutory training and now have a computer for the sole use of training. The COSHH records and risk assessments are held where the domestic staff can read them and are produced by a company who buy in the products and produce the safety card. These information sheets were seen that are used by domestic staff and a separate one for the kitchen staff. (Staff knew where to find the safety data sheets when required on asking). The hot water was checked in three areas by the inspector and written records were seen that stated temperatures were correct. The inspector receives notification under regulation 37 for deaths with 5 records received at the commission since the last inspection. This corresponded with records held within the home. The Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 20 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 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 3 The Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13.2 Requirement The registered person must ensure that all medication administered is seen ingested before signing for the medication and not left on the dining room table. The registered person must ensure a review of the quality of the service takes place and is available for residents and the commission. Timescale for action 07/06/06 2 OP33 24.2 01/09/06 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 Refer to Standard OP15 OP7 Good Practice Recommendations The meals should be offered in separate containers and sauces in jugs to allow choice and amounts required by the residents at the table. The care plans need to be on a format that is easily understood and available for residents. The Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Warren DS0000067710.V299143.R01.S.doc Version 5.2 Page 23 - 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!