Inspection on 28/06/07 for The Warren Nursing Home

This inspection was carried out on 28th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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.

Other inspections for this house

The Warren Nursing Home 29/06/09

The Warren Nursing Home 02/02/06

The Warren Nursing Home 14/12/05

The Warren Nursing Home 19/01/05

The Warren Nursing Home 23/09/04

The Warren Nursing Home 17/02/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Warren Nursing Home Cluden Road Northam Bideford North Devon EX39 3QF Lead Inspector Susan Taylor Key Unannounced Inspection 09:30 28th June 2007 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 Nursing Home DS0000026727.V333677.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 Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Warren Nursing Home Address Cluden Road Northam Bideford North Devon EX39 3QF 01237 476932 01237 421214 riverbankcare@uk2.net 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) Riverbank Care Limited Mrs Jacqueline Thisby Mrs Laura Jane Hobbs Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places The Warren Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Notice of Proposal to Grant Registration staffing/environmental conditions of registration was issued 20/4/2001 Registered for 30 - Elderly General Nursing Care. Registered for 2 Elderly Residents Total number registered is 32 Authorised person in charge is Laura Hobbs RGN Date of last inspection 2nd February 2006 Brief Description of the Service: The Warren provides 24-hour nursing care to older people. The home is a detached property situated within easy reach of the facilities of Northam, Westward Ho! and Bideford. Originally an older type property it has been converted and also extended to provide accommodation in 21 single and 5 double bedrooms. A passenger lift enables service users to access all areas of the home. There is a car parking area. To the front is a lawn area that is pleasant and easily accessed. Riverbank Care Limited is a member of the Registered Nursing Homes Association, and has achieved the Investors in People Award. At the time of the inspection, the fees ranged from £287 to £504 per week. Extra charges are made for Hairdressing [£6.50 to £21], Chiropody [£11] Personal toiletries [variable], Personal taxis [variable]. The Warren Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place on the 28th June 2007 commencing at 09:30 hours and lasted 9 hours. In that time we toured the home and spoke to 4 people who live in the home. We also spoke to 2 relatives who were visiting and 4 staff who work at the home. After the tour we looked at 4 files that were about the people we spoke to who live in the home, this is called case tracking. We spent time observing the care they received during the day. We also looked at 3 staff files, including those of the staff we spoke to, and several records that verified maintenance and the homes quality assurance checks. The Registered Manager had provided us information prior to the inspection about changes, the people living in the home and staff. We also received responses from 10 staff, 1 professional, 3 relatives and 4 people that live in the home in survey forms sent out by the us (Commission for Social Care Inspection). The comments in these are included in the report and helped us form judgements about the service people receive. What the service does well: People tell us that the Warren is a “homely” place to live. The home obtains important information about people prior to agreeing to them moving in to make sure that their needs can be met. Care plans are well structured and provide staff that care for people with detailed information about their needs and desires. People know what to expect and told us that they are very satisfied with the care they receive. The staff maintain good links with other healthcare professionals that benefits people’s health and general well being. The home provides a good level of planned and spontaneous activities that are appropriate both in choice and structure for older people, some of whom have dementia. People that live at the home tell us the accommodation is very comfortable and that is “very well maintained”. We also found this to be the case. A wide range of specialist equipment has been purchased by the home to ensure that people are properly cared for. Visitors tell us that there is an open atmosphere and they are encouraged to visit their relatives that live there whenever they want to. Similarly, people told us that the Warren is very much part of the local community. People are encouraged to take part in local fund raising and social events and enjoy this immensely. The Warren Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 6 The food is freshly prepared by the kitchen has been reported to be of an excellent standard by both the people who live in the home and their visitors. They told us it was “fantastic”, “wholesome” and “very good quality”. People living at the home, their visitors, staff and professionals tell us that concerns are taken seriously and dealt with promptly. The staff are well trained in how to care for older people and they do this in a respectful way that maintains the dignity of the person being cared for. 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 summary of this inspection report can be made available in other formats on request. The Warren Nursing Home DS0000026727.V333677.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 Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 Quality in this outcome area is excellent Information about the service is readily available for people and enables them to make an informed decision about whether the home is the right place for them. The Warren has a comprehensive assessment process ensuring that people’s needs are well known, reviewed regularly and form the basis of person centred planning. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 100 of people living in the home and their relatives verified in a survey that the home had provided them with information that enabled them to make decisions about moving into the home. An information pack had been developed for prospective, new and existing users to read. The pack The Warren Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 9 contained interesting news about the home and links with the community: There were photographs of a local football team that the home sponsers and photographs of a football team in a village in Africa that had been sent a football strip; volunteers from the North Devon Animal Ambulance had visited people in the home regularly with pets that needed rehoming and photographs showed people with the animals. The manager told us that people are assessed initially by her either at home or in hospital to establish whether their needs can be met at the Warren. The pre admission form seen included information about their current abilities, medication, next of kin and equipment required. We examined three care files for two people with dementia and a person that had had a stroke. A thorough assessment of needs had been completed with people and their relatives when they moved into the home. Assessments completed established risks for an individual about their handling, tissue viability, falls, continence and nutritional needs. Additionally, information about the individual had also been obtained from social services if the care package had been commissioned by them. In a survey, 100 of people living in the home and their relatives felt that the home always or usually met their needs. Intermediate care was being provided for one of the people whose care we tracked. The home were working with the individual to rehabilitate them following a recent stroke. Daily care records demonstrated that the person was having intensive physiotherapy at the local hospital. Various types of equipment had been obtained for the individual to enable them to regain their independence with a view to them returning to their own home. The Warren Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is excellent. The Warren provides person centred care for the people that live there. The team utilise all the resources available to them to ensure that the care the deliver to people is based on best practice. The management of medication ensures that people receive the right medication and the right time and are closely monitored. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 100 of people responding in a survey verified that they were listened to and that staff act on what they say. Additionally, they verified that care and support matches that planned. According to the pre-inspection questionnaire the current group of service users include nineteen people with dementia, and The Warren Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 11 one person with mental health needs. Additionally one person was highlighted as presenting extreme behaviour. Three care files were examined. Nurses are employed as key workers, who have overall responsibility for managing the care for individuals. Needs and risks that had been identified at admission were always reflected in care plans. Reviews had taken place regularly documentation about one person who was debilitated and at risk of tissue breakdown had been assessed. Written strategies were in place to minimise these risks, including the use of pressure relieving equipment. We met the person concerned and saw that they were sitting on a pressure relieving cushion as outlined in the care plan for that individual. The person confirmed that the plan of care had been discussed with them and confirmed that staff were vigilant in ensuring that they sat on pressure relieving equipment and were helped to use the toilet regularly enabling them to stand with assistance. A handling plan was examined, which outlined that two staff were always needed for transferring the person from bed to chair and chair to bed. The individual concerned verified that staff used a stand aid when they needed to transfer. Other care plans seen gave sufficient detail about the needs of each person and it was evident that wherever possible the individual and/or their next of kin had been fully involved in the process. Care delivered to the individuals whose records had been inspected was observed as being excellent. We saw that specialist equipment was being used for one individual that had been recommended after physiotherapist and tissue viability nurse specialist involvement. The person concerned had been admitted to the home from hospital with a stage 4 pressure sore that required intensive treatment. A detailed wound assessment had been completed and charted a pattern of consistent healing - a good outcome for the individual. Multidisciplinary records demonstrated that their GP and other specialist healthcare professionals had visited the individual regularly. We tracked the medication that had been prescribed for the three individuals and how it was administered by nursing staff. One person required strong analgesia that was kept securely in a locked cabinet within a locked cupboard that meets legal requirements. We observed that procedures were followed precisely with this medication in terms of checking, record keeping, and witnessing. All other medication was kept in a Bristol Maid trolley, which the nurse took to each person and then recorded that it had been taken. The nurse told us that they had overall responsibility for managing medicines coming into and leaving the home and that regular audits was carried out. A random check of medicines verified that that medicines were all within date. The home had changed the pharmacy it used to dispense medication and a pharmacist had recently visited and reported on the management of medication at the Warren. We read the report - no recommendations had been made. The Warren Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 12 All of the people living in the home and relatives responding in a survey felt that peoples privacy and dignity was well met. In a survey of people living at the home, their comments included I have my own doctor. Relative made positive comments about the care people receive, which included we think mums needs are met very well considering all things and residents are kept clean, comfortable and well dressed. Staff responding in a survey wrote comments like personal hygiene and appearance of the clients is very important to us and is performed within their wishes The Warren Nursing Home DS0000026727.V333677.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): 12, 13, 14 & 15 Quality in this outcome area is excellent. Routines and activities are flexible and suited to individual people’s needs. The people that live at the Warren have choice and control over their lives and benefit from regular contact with their friends and family. The preferences and tastes of people living at the home are known and meals are an enjoyable social event. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We spent time in the lounges observing how staff interacted with the people living there. This highlighted examples of excellent practice. During the period of observation, staff involved people in small groups to participate in a choice of activity. Staff engaged with people continuously at the right speed and demonstrated genuine warmth and attention, which people appeared to respond to and enjoy. Records held about people living in the home included information about their social, economic and cultural histories. This approach The Warren Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 14 was person centred and provided the staff with in-depth knowledge about the people they care for such as their family and working history as well as their hobbies and interests. People we spoke to also confirmed social activities are arranged, they spoke of occasional trips out of the home. Activities are advertised by word of mouth, with staff telling them what’s available; a notice advertising these was seen in the main hallway and was up to date. Responding in a survey a relative wrote games both board that involve thinking and games that involve movement of limbs are introduced to the more able on some days during the week it would be nice if they gave my mother the mobile phone, which is available for me to call at any time to call me it would be a wonderful surprise. A person living in the home had recently done the Walk for life and had raised £90 for Cancer Relief. We were shown photographs of this event. People we spoke to told us that they have a lot of fun doing things in the community. In the Spring they had a pancake race and some of the people taking part were in wheelchairs. We observed how the team worked to meet the needs of a person that had recently had a stroke. An early lunch had been organised for them because they were going to a funeral in the afternoon. The cook helped the person cut up the meat on their plate, which was placed on a non-slip mat with a plate guard attached. This enabled the person to be independent. Whilst chatting about the home, the person told us that the food is fantastic and that they had been on various trips out including shopping at the local supermarket, enjoyed a fish and chip supper from a local restaurant and ice cream. Responding in a survey a person living in the home wrote, The meals are very nice very good. On the same subject a relative wrote, The home is very sympathetic to my mothers tastes and helps accordingly. Another person wrote staff help residents take their meals when the residents cannot help themselves. (The food) is very wholesome, varied and adequate meals are available The Warren Nursing Home DS0000026727.V333677.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): 16 & 18 Quality in this outcome area is good. The Warren’s arrangements for the protection of vulnerable adults, including dealing with complaints, ensures that people living there are protected and able to voice their concerns This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure was displayed in the entrance hall and complaints forms were also available. Three people who had their care ‘case-tracked’ said they were aware of how to make a complaint and knew who to speak to; if they were not happy they said they would talk to ‘the manager or staff’. Everyone said they had nothing to complain about and that they feel safe living in the home. According to the pre-inspection questionnaire no complaints had been received by the home. No complaints were made to us during the inspection. 100 of relatives in a survey verified that they knew who to speak to about concerns and that they had confidence that it would be investigated. Similarly, 100 of service users in a survey also knew who and how to make a complaint. At the The Warren Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 16 same time, all of service users in a survey felt that the staff listened and act on what they say. According to the pre-inspection questionnaire no POVA referrals had been made. All of the people living in the home that responded in a survey verified that the staff listened and acted upon what they say. Similarly, 100 relatives felt that their relation and other service users were treated very well. According to the pre-inspection questionnaire one person presented extreme behaviour. However, on further exploration and in discussion with the manager we were told that the person had been assessed and had since moved on to a more appropriate care setting. 60 of staff responding in a survey verified that they understood adult protection procedures. Our observation of interactions between staff and people living in the home concluded that there was genuine warmth and concern for vulnerable people. We observed that people living in the home were happy and confident with the staff caring for them. Staff told us it has been drummed into us to always ask for consent before we do anything with people who need care. Similarly staff felt that it was really important to get to know the people they are caring for. Staff that did not understand adult protection procedures told us that they were either domestic, kitchen or administrative staff and did not therefore deliver intimate personal or psychological care to people living in the home. We examined a selection of personnel files to establish whether basic information about POVA, abuse was provided for ancillary staff during the induction process. None of the ancillary staff had received an induction. The manager also verified this to be the case. This matter is dealt with under the management section of the report. A relative responding in a survey wrote, have never had any cause to raise concerns, but Im confident they would be dealt with appropriately. The Warren Nursing Home DS0000026727.V333677.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): 19 & 26 Quality in this outcome area is excellent. People live in comfortable accommodation that is suitable for their needs and is maintained to a high standard. Procedures in the home are followed and ensure that people are kept as free from infection as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw that the accommodation was well maintained as we toured the building. People told us that the home was maintained consistently to a high standard and always spotlessly clean. This view was also reflected in all of the surveys we received from people living in the home. We looked at records, which demonstrated that routine maintenance had been carried out to the The Warren Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 18 heating, gas & fire precaution systems and equipment. The grounds were tidy, and attractive with herbaceous perennials and shrubs. The accommodation provided comfortable, homely fittings and fixtures. In a survey staff wrote, If there is a genuine need for any equipment to be used for both clients and staff, the owners dont hesitate to obtain these items. The manager told us that if any equipment is broken it is immediately replaced with new equipment. Written records demonstrated that the home has measures to minimise the risk of cross infection. We observed staff using alcohol gel and protective clothing such as aprons and gloves whilst they were delivering personal care to people. Information provided by the manager verified that there had been no outbreaks of infection. Similarly, we saw good outcomes of care for people whose care we tracked. The Warren Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 19 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 & 30 Quality in this outcome area is good. There are sufficient numbers of staff with appropriate skills and knowledge to meet the needs of people who live in this home.The recruitment procedures and staff training protect the people who live in the home from being placed at risk of harm or abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employ’s staff in suitable numbers, and with sufficient skills, each shift, to meet the nursing cares needs of the people who live there. We discussed the staffing arrangements with the Registered Manager and how staff are deployed through out the day. We looked at duty rosters for three weeks prior to the inspection, which showed that the home was always in the control of a Registered Nurse. In addition to the nursing and care staff the home employs administrative, catering, domestic, and laundry staff. Additionally, there is maintenance staff. We looked at the training that staff complete, and the Registered Manager provided a copy of the training matrix that records the type of training carried by each individual employed at the home, and when the training took place. From this we saw that everyone has The Warren Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 20 had a full induction period that extends over the 3-month probation period and that there performance is monitored for this period before a decision to fully employ him or her is made. We saw that staff have had fire training, moving and handling, infection control, and that many have had Health & Safety training. The level of National Vocational Qualification training for care staff exceeds 50 with care staff continually being involved in this training. When looking in the 3 staff files that we sampled we saw certificates that verified that the training mentioned had taken place. The home had a recruitment procedure that provided suitable protection to the people who live in the home from inappropriate staff being employed. It included a full application form that asked for a past employment history. Two written references had been obtained, in addition to a Criminal Records Bureau and POVA first check. In two out of the three files references had been sent for but not received until after the individual had commenced employment. The provider told us that they had recognised that this was unacceptable practice and had recently changed the procedures to ensure that references were received and assessed as being satisfactory before employment was offered to applicants. We looked at another file for an applicant that demonstrated that this was being followed. We also saw that each individual had been issued with terms and conditions of employment. All of the staff we spoke to told us that they are given “Staff Handbook” that includes information about their employment at the home and policies and procedures that reflect on how their behaviour will be addressed if it does not meet with the expectations of the home. During the inspection we spoke to 4 staff members from different areas of work within the home and who each had different lengths of service and qualifications. Collectively they felt that the Registered Manager did support them to receive a good level of training that is appropriate to their role in the home. One person who was recently employed told us that their induction included shadowing someone for a week before they could undertake any duties, as they were new to care work. They said they had had a good induction that prepared them for the work that they would do. They said that they liked everything about the workplace, the staff and the people who live there. The professional nurse we spoke to said that she enjoyed her work in the home and felt well supported and had plenty of opportunities to maintain their professional practice. The Commission received 10 out of 11 staff survey forms. All gave very positive feedback about their experience of working at the home. They said that they received adequate training and support, and that if a problem arises they are able to discuss the issue at any time with a senior member of staff. Staff verified that they feel that the home provides, “The highest quality care to be given, as well as supporting and looking after the staff”. Half of the staff responding in a survey verified that they had not recently had a one to The Warren Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 21 one session with their manager, had their practice observed or attended a staff meeting. This was discussed with the manager who told us that this was being addressed. A relative told us The staff at the Warren were wonderful with Dad and with us, so caring, kind and compassionate, we could not ask for more. The Warren Nursing Home DS0000026727.V333677.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): 31,33, 35 & 38 Quality in this outcome area is good. The overall management of the home and the care of the people who live in it are good. Quality assurance systems are in place to take account of peoples views. A more proactive approach needs to be taken to ensure that equipment used when caring for people is fit for the purpose. There are shortfalls in respect of induction procedures, which are not applied consistently with ancillary staff. All other aspects of health and safety are managed to a high standard and safeguard people living at the home. This judgement has been made using available evidence including a visit to this service. The Warren Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 23 EVIDENCE: The Registered Manager is an experienced nurse and she has been in charge of the establishment for several years. She holds the Registered Managers Award, a Diploma in Management. She is competent at her role and demonstrated this by having an excellent overview of all the areas of the home that collectively help the home to meet its aims and objectives. We observed that there are clear lines of accountability within the home. The Registered Manager has a team of people who assist her in meeting the needs of the people who live in the home and also the business. The registered providers are also very much hands on and visit the people that live there daily. We spoke to four staff and observed practice throughout the day and saw that there is an open door policy that also allows people living there, visitors and staff to speak with the Registered Manager should they wish to do so. A visitor’s whose relative had just been admitted said that the Registered Manager had told them all about the home, and the complaints procedure, before they had read the statement of purpose, and that they valued this contact with her so early in the admission. We discussed the certificate of registration with the manager and provider since the Commission is currently reviewing these. The manager, provider and inspector all agreed that the conditions of registration no longer applied and should be removed from the certificate. The manager showed us an information pack that had been developed after she had read the Commissions document entitled KLORA (Key lines in regulatory activity) upon which judgements are made about the overall service people living there receive. She told us that the aim of doing this was to provide people with a lot of information about what they can expect living at the home. The pack had an interesting mix of news and general information about the service. It was evident that the home had clear links with the local community and beyond. Similarly, the manager told us that they were using KLORA and the AQAA (Annual Quality Assurance Assessment) as a framework for developing a quality assurance strategy for the home. As a result a quality circle had been established that includes people living in the home, relatives and staff. An audit meeting had been held to discuss particular aspects of the service. In a survey staff wrote, the matron sets a very good example and is very much a hands-on manager. A relative wrote in a survey this is a very pleasant home and I am extremely happy that she has moved here. A The Warren Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 24 relative who was visiting during the inspection told us that they thought care was excellent and that the team were all very committed to improving the home. In terms of what people thought that the home can improve on I think that a physiotherapist would be useful to assess each resident and ..there are times when they are understaffed, but they seem to oh overcome this very well In a survey staff responding praised the management of the home, and their comments included Im quite pleased with the overall supervision of staff by the owner and manager and their obvious concern for the care of residents and their willingness to introduce improvements is thought necessary . Relatives responding in a survey comments included There is such a warm friendly and welcoming environment when you come into the Warren, it feels like a friends home. As far as I was concerned whenever I visited Dad he always looked so clean and smartly dressed. It meant so much to me to see him looking immaculately as the always like to be and an excellent care home, so well run and with excellent staff and they give attention to detail, it after a visit asked for something for my mothers needs all care when I next visit its always been done and it is a very well-organised, caring home where the quality of care was excellent and patients wishes and needs are respected. Everything is geared to giving the client the best quality of life. The home does not manage money on behalf of people that live there. People we spoke to verified that they either did this for themselves or their relatives did this for them. We tracked the needs of three people living at the home and examined accident records pertaining to them. One person had fallen on 7/5/07 and an accident record had been completed which highlighted that this had happened because a bedside was faulty. The matter had been reported to the Falls coordinator at North Devon Primary Care Trust. The manager told us that a screw had come loose and had caused the bedside to break. The bedside had been subsequently replaced. We were shown receipts for this. On further discussion, the manager verified that if any equipment malfunctions in the home it is immediately replaced rather than repaired. In light of this we recommended a proactive approach in which equipment is audited regularly to ensure that it is fit for purpose. Comprehensive Health & Safety policies and procedures were seen, including a poster displayed stated who was responsible for implementing and reviewing these. Certificates seen in four staff files verified that staff had attended infection control and manual handling training in the past 12 months. We observed hand sanitizer being used by staff to minimise the risk of cross infection. The fire log demonstrated that fire drills, had taken place regularly. All of the files had certificates to verify that fire training had been provided in The Warren Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 25 the last 12 months. All of the people we spoke to told us that the alarm was regularly checked. Certificated evidence verified that the hoists had been regularly maintained. First aid equipment was clearly labelled. Some of the staff on duty verified that they held a current first aid qualification having completed the National Vocational Qualification in Care. Good manual handling practice was observed as carers transferred people from wheelchairs to chairs in the dining room at lunchtime. We examined a selection of personnel files to establish whether basic information about POVA, abuse was provided for ancillary staff during the induction process. None of the ancillary staff had received an induction. We spoke to three domestic staff all of which verified that they had not received an induction when they started work at the home. The manager also verified this to be the case. A relative responding in a survey wrote, have never had any cause to raise concerns, but Im confident they would be dealt with appropriately. The Warren Nursing Home DS0000026727.V333677.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 4 x 4 x x 4 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x x x x x x 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x 2 x 3 The Warren Nursing Home DS0000026727.V333677.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. Standard Regulation Requirement Timescale for action 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 OP38 OP38 Good Practice Recommendations The Warren Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP 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 Warren Nursing Home DS0000026727.V333677.R01.S.doc Version 5.2 Page 29 - 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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