Inspection on 01/03/06 for The Warwickshire

This inspection was carried out on 1st March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Warwickshire 11/08/08

The Warwickshire 11/02/08

The Warwickshire 14/08/06

The Warwickshire 24/05/05

The Warwickshire 25/02/05

The Warwickshire 30/11/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Warwickshire Main Street Thurlaston Rugby Warwickshire CV23 9JS Lead Inspector Jackie Howe Unannounced Inspection 1st March 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 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 Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Warwickshire Address Main Street Thurlaston Rugby Warwickshire CV23 9JS 01788 522405 01788 817260 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) Mr R A Perry Mrs Perry Mrs Jeanette Margaret Corby Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46) of places The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th May 2005 Brief Description of the Service: The Warwickshire Nursing & Residential Home is set in the small village of Thurlaston, near Rugby. The nearest amenities and shops are in the near by village of Dunchurch. The home can be reached via public transport although this is not very regular. The nearest bus stop is approximately ½ mile away, on the main Dunchurch road. The Warwickshire is a large home set in its own grounds, which are laid to lawn and flowerbeds. The home provides accommodation, with nursing and personal care to frail elderly persons. and palliative care to elderly persons over 60 years. The bedroom accommodation is in either single or shared rooms. Several of the rooms are suites that are large enough to accommodate couples. A balanced nutritious diet is available to all service users, and there is entertainment and other planned activities ongoing in the home. The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over a period of seven hours. This was the second visit of the inspection year 2005/06. The inspection was undertaken with the manager and included a tour of the home, speaking with staff and residents, accessing records and reading care plans. During the inspection ten residents, six staff and two relatives were spoken with. What the service does well: What has improved since the last inspection? CRB checks have been received for all care staff in the home, and ‘POVA First’ checks have been undertaken. A quality assurance survey has been undertaken, but the results of this are unknown to the staff and a report on the findings has not been published. A programme of maintenance work has ensured the completion of the majority of shortfalls identified in the previous report, with some work still identified in The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 6 regard to fitting radiator guards. ‘Dorguards’ have been fitted to a number of doors but more are needed to stop the practice of wedging open bedroom doors, particularly on the top floor. Care plans are now held securely. 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 Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 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 Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 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 Pre admission assessment information lacks sufficient detail in some areas to determine whether individual care and support needs can be met. EVIDENCE: The manager and her deputy undertake pre admission assessments. Social services’ assessments are also obtained for those residents admitted under care management arrangements. The needs assessments read, had not been completed in sufficient detail, and risk assessments to ensure personal safety, had not been undertaken in some areas, especially in regard to the use of bed rails. Information in relation to the social interests, hobbies religious and cultural needs was limited, and therefore these were not reflected in the care plan for longer-term outcomes. The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 9 The manager and her staff do not currently undertake nutritional screening on all residents admitted to the home. It is important this is completed on all residents to indicate if a longer-term care plan is required, and to ensure a thorough base line assessment. Residents spoken with said that they felt their needs were being met. One resident had been transferred to the home as she had increased care needs. Her daughter who was visiting confirmed that she was very happy that the home was able to care for her mother in the way she preferred. The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8 Arrangements for ensuring that the health, personal and social care needs of residents are identified and meet the needs of the residents in the home. EVIDENCE: The home employs a good level of nursing staff, who offer stability to the home. The registered manager spoke positively about maintaining resident’s health needs, and actively promotes this by ensuring access to health professionals. A Chiropodist visits every 12 weeks; the promoting continence service visits regularly, as do the dentist and optician. Resident’s psychological health receives support from the CPN service, and hospital psychologist has been consulted in the past. The tissue viability nurse offers advice to the home, and the manager said she attends regular meetings with the PCT. There is one resident currently who has a pressure sore; she is being cared for in bed and the area is healing well. The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 11 Photographs are not currently taken of wounds; and it is recommended that this be done, with resident’s permission, especially on new admissions to the home. All photographs should be dated to show signs of improvement or deterioration. Hearing services are provided by the hospital, but the manager said that the home has been experiencing problems accessing this service of late. Residents spoken with confirmed that they were happy with their health care, and one lady said how she felt she had improved since coming to the home. The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 12 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): 14 Service users are enabled to make choices about visitors and daily living routines. A varied and nutritious choice of foods is offered by the home in consultation with service users. EVIDENCE: The manager has in the past used advocacy services for the residents, but said she has recently experienced problems accessing them due to lack of staff within the advocacy services. The manager and the assistant manager have a commitment to offering choice to the residents in the home. Residents are able to choose their own key worker within a team, and evidence was seen that residents are called by their chosen name, have choice over what time they get up and what they have to eat. Choice around meals provided is particularly good. Discussions with the cook confirmed that she is proactive in offering choice. One resident who has always preferred to eat his main meal in the evening, is given a snack at lunchtime, and a hot meal is provided later in the day. The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 13 Visitors were seen freely coming into the home and greeted positively by the staff. Concerns were raised at the last inspection about the practice of giving relatives a key to the front door. A risk assessment has been undertaken as identified in the last inspection report with regard to the practice of giving the front door key to relatives. The manager feels that the risk is minimal to other methods previously used, and is changing the key code on the back doors periodically. The atmosphere in the home during the inspection was happy and residents were interacting both with each other and with the staff. The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 14 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, 18 The home has a complaints policy and procedure for residents and their representatives to access, but a lack of recording does not make it clear to interested individuals how complaints have been received, investigated and if they have been upheld. Working and care practices observed indicate that residents are protected from abuse, however a lack of available training records does not demonstrate that staff have been adequately trained to recognise different forms of abuse and understand the home’s policies and procedures to offer protection. EVIDENCE: Records held indicate that the home has not received a complaint since 2003. The manager said that most ‘complaints’ raised with her are in the format of a concern or question, rather than a complaint, and she feels she is able to deal with these in a ‘one to one chat’. No detail has been made in the record about investigations undertaken, or if the complaints received and recorded, had been upheld. Discussions were held with the manager about the value of recording both formal and informal complaints, so that she can monitor where there is dissatisfaction with the service, and identify where improvements can be made. The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 15 The complaints procedure for the home is displayed on the notice board in the home, and in the Service Users Guide, which is given to every resident. Residents spoken with said that they were happy with their care, the attitude of staff and have no reason to complain about the service they receive. The home has policies for staff to follow in recognising and responding to signs of abuse, but although some training has been attended by staff, this has been limited, and the manager was unable to provide evidence of when training had last been attended and by whom. Improved recruitment procedures offer the residents protection. The manager and her deputy have in the past, followed correct procedures for reporting concerns. The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 16 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): These standards were not assessed at this inspection. EVIDENCE: Whilst these standards were not assessed in detail, a tour of the home indicated that the home is generally well maintained, and the majority of the work identified in the last report has been completed. Some areas of the home are looking a little tired and the manager said they were identified for decoration. Some furnishings are worn and a lounge chair was split on the arms showing the foam underneath. A fire extinguisher was hidden by a chair and not easily accessible, and bedroom doors of residents cared for in bed, were wedged open. Discussion with staff indicated that action on this would be undertaken within the next few weeks as part of an ongoing programme. The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 17 An area of the lounge used as a storage facility for wheelchairs, should be reviewed to permanently block an opening leading into the ‘gents lounge’ which the manager said was unused by residents. A set of sit on scales was obstructing the opening. The inspector recommends that the fire department be consulted about the re-siting of the fire extinguisher and the permanent closure of the doorway to provide a more permanent storage facility, and improve the environment and safety for residents. The home has sufficient communal space to allow residents freedom of choice, with television and quiet areas provided, as well as a separate smokers lounge. A number of original features of the existing building have been retained which gives character to the home. The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 18 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, 30 The staffing of the home is adequate and the recruitment policies and procedures have improved to ensure the support and protection of the residents. Training and supervision of staff in their roles is insufficient, and training records were unavailable for inspection. EVIDENCE: Staffing levels in the home on the day of the inspection, and the duty rotas appear to meet the needs of the service users in the home. There are a number of staff employed in ancillary roles to support care staff. Staffing in the kitchen is particularly commendable. The home employs a number of overseas staff who have attained nursing qualifications in their own country of origin, but are working in the home in a supporting care role. These staff have had CRB checks undertaken as identified in the last report. The manager said she is able to ‘buy in’ additional staffing through continuing care provision. Student nurses are working in the home on training placement, but these are always supplementary to the staffing rota. The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 19 Training records were unavailable for inspection, but discussions held with the manager indicate that not all staff have received sufficient training to meet the required standards. The manager must ensure that all staff are given training in all essential areas i.e. Fire safety, Manual Handling, Infection Control, and Health and Safety, and that this training is updated at sufficient intervals to fulfil the aims of the home and meet the needs of the residents. Induction for new staff is based on the TOPPS requirements and staff are given mandatory training via in house trainers and support training videos. The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 20 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): 35, 36 Systems for the management of residents’ finances ensure that their interests are safeguarded. Not all staff have received supervision addressing the necessary specifications and at the required intervals. EVIDENCE: Very few residents choose to keep their own money or make use of the home’s secure facilities. Those who do keep their own money, are offered an individual safe or a lockable draw Where residents do use the home’s safe, separate records are kept, and money is held separately. Records and money checked at the inspection were found to be correct. The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 21 The home raises invoices for services such as chiropody and hairdressing. Where possible the home uses Advocacy Alliance to act on a resident’s behalf in financial matters. Discussions with the manager confirmed that not all staff have received regular supervision and that records have not been kept. Meetings are held and staff are guided at handovers and in nurse led training sessions, to meet the needs of the residents in the home. This is insufficient for the manager to fulfil her role in ensuring that the staff are suitably competent and experienced, and therefore fit to work in the home. A general discussion was undertaken with the manager to look at ways this could be immediately improved whilst a more formal system is introduced. The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x 3 2 x x The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Timescale for action 01/06/06 2 OP28 18 3 OP36 18 A service user plan generated from a comprehensive assessment must be drawn up with the service user and/or their representative and in sufficient detail to ensure that all aspects of the health, personal and social care needs of the service user are met. These must include assessments for pressure sores and nutrition. Records for individual must be maintained on a daily basis. (Previous time scale not met) The manager must ensure that 31/12/06 there is a minimum of 50 of the care staff with NVQ level 2 qualification or equivalent. (Previous timescale not met). The registered manager must 30/06/06 maintain regular formal supervision at least six times a year with nursing and care staff. (Previous time scale not met). The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 24 4 OP3 14 5 OP16 17 6 OP18 13 7 OP30 18 8 OP38 23 The registered manager must ensure that a full and detailed pre admission needs assessment is undertaken on all areas identified in the standards, and that risk assessments are completed on nutrition and the use of bed rails. The registered manager must ensure that a record is kept of all complaints received, investigations undertaken, and if a complaint has been upheld. Records of these must be made available for inspection. The registered manager must ensure that all staff are trained to recognise all forms of abuse and demonstrate that staff are aware of policies and procedures in place to safeguard residents in the home. The registered manager must ensure that all staff attend training appropriate to their work and that detailed records are maintained of such training and are available for inspection. The registered manager must ensure that all fire extinguishers are easily accessible, and the practice of wedging open bedroom doors is risk assessed, until ‘dorguards’ are fitted. 30/06/06 30/06/06 30/06/06 30/06/06 01/05/06 The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 25 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 Refer to Standard OP30 OP30 OP38 Good Practice Recommendations The inspector recommends that the manager access distance learning training courses to assist with meeting training objectives. The inspector recommends that the manager join a support organisation, which would give her access to other professionals and training opportunities. The inspector recommends that advice is sought from the fire department about improving and making safe the wheelchair storage area currently used in the lounge. The Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Warwickshire DS0000004326.V285498.R01.S.doc Version 5.1 Page 27 - 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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