Inspection on 11/08/08 for The Warwickshire

This inspection was carried out on 11th August 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Warwickshire 11/02/08

The Warwickshire 14/08/06

The Warwickshire 01/03/06

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 13/11/2008.

CARE HOMES FOR OLDER PEOPLE The Warwickshire Main Street Thurlaston Rugby Warwickshire CV23 9JS Lead Inspector Yvette Delaney Key Unannounced Inspection 11th August 2008 10:00 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.V371608.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 Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Warwickshire Address Main Street Thurlaston Rugby Warwickshire CV23 9JS 01788 522405 01788 817260 WARKS97@aol.com 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.V371608.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th February 2008 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 does not run very regularly. The nearest bus stop is approximately ½ mile away, on the main Dunchurch road. The home provides accommodation, with nursing and personal care to frail elderly persons and palliative care to up to 46 elderly persons over 60 years. The bedroom accommodation is in either single or shared rooms. Some of the bedrooms have en suite facilities, although not all en suites are easily accessible. The Warwickshire was originally a 19th century manor house, which has been converted and extended to make a large care home. It is set in its own extensive grounds, which are laid to lawn, meadow and flowerbeds. The manager told us that the range of fees payable for living at The Warwickshire is £500 to £850 per week. Additional charges are made for hairdressing, private chiropody and other sundries such as newspapers and toiletries. The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this home is 1 star; this means that the home overall provides adequate outcomes for the people who use the service. This was a Key unannounced inspection which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents’. The inspection focused on assessing the main Key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. Questionnaires were completed and returned by eight people living in the home, a relative and three members of staff, giving their views of the service. An annual quality assurance assessment (AQAA) was completed and returned by the manager in time for the inspection. Information provided in the annual assessment by the home manager has been used to inform this report. The inspection included meeting most people living at the home and case tracking the needs of three people. This involves looking at people’s care plans and health records and checking how their needs are met in practice. Other people’s files were also looked at in part to verify the healthcare support being provided at the home. Discussions took place with some of the people that live at the home in addition to care staff and the home manager. A number of records, such as care plans, complaints records, staff training records and fire safety and other health and safety records were also sampled for information as part of this inspection. Three people who were staying at home were ‘case tracked’. This involves establishing an individuals experience of living in the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on the outcomes for the resident. Tracking peoples care helps us to understand the day-to-day life of people who use the service. The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 6 What the service does well: Comments received from residents and relatives on what they felt that the home does well include: • • • • • • • Interacts with residents very well. Each person is treated as an individual and with respect Food is well thought out and of good standard Cleanliness and hygiene is of a very good standard The staff are cheerful, friendly and caring “I am pleased with the staff and care I get.” Cares for people who are ill with compassion Our visit to the home also showed that: Pre-admission Assessments completed by the home manager provides sufficient information to support staff in completing appropriate and meaningful care plans. Meals served by the home, including soft diets are well presented and appetising. This encourages residents to eat a nutritious diet, which will help to promote their wellbeing. What has improved since the last inspection? The manager has addressed all of the requirements made at the last key inspection of February 2008. These include: Reviewing care plans to ensure that people using the service have an up to date, detailed care plan, which provides details of residents individual care needs. This will ensure that they receive person centred support that meets their needs. Nursing staff signing Medicine Administration Record (MAR) charts following the administration of medicines and a reason for non-administration is recorded. This ensures that the MAR charts reflect what medicines have been administered to people living in the home. Staff files examined at this inspection visit, shows that recruitment practices have improved. Sufficient information is available to determine the fitness of potential employees before they start working at the care home. This will ensure that the home’s staff recruitment practices safeguard people living in the home. Records required by Regulation, which include: care plan documentation, staff files, The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 7 records detailing the servicing of equipment used in the home and records demonstrating maintenance and ongoing refurbishment of the home have been reviewed to ensure that they are readily available and maintained in a format that makes them easily accessible. Records examined also show that they are up to date to contain current and accurate information. This will ensure that the best interests of people living in the home are maintained within a safe environment. Notifications of events or incidents, which affect the well being of the residents accommodated in the home, have been notified to the Commission. These show that the home is being run in the interests of people living in the home and that appropriate actions are taken to safeguard vulnerable people living in the home. The sluice door is kept locked to minimise the risk of harm to residents in the home. Entries in care plans and daily reports are dated, timed and signed with the signature of the person writing the entry. This will ensure that a legible and effective audit trial is available to track the care given to people living in the home. What they could do better: One requirement was made following this inspection visit and four recommendations. Areas discussed in this report, which identifies where the home could do better include ensuring that: Procedures are in place to reduce the risk of infection or cross contamination in the home. This must include: Ensuring the temperatures of the fridges and freezers are consistently and accurately recorded. Ensuring that the freezers are defrosted. This will help to confirm that they are working properly. Ensuring that meat products are defrosted on the bottom shelf of the fridge and no other food products are placed underneath them, which could lead to contamination. Ensuring that records related to daily, weekly and monthly cleaning schedules in the kitchen are easy to read and are completed and signed for as the task is completed. This will ensure the health and wellbeing of people who live in the home. The Statement of Purpose and Service User Guide should be updated and available in alternative formats. This will ensure prospective residents have all necessary current information to enable them to make an informed decision about using the home. The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 8 Residents should be consulted about a programme of activities that takes into account their individual and group needs. This will ensure that appropriate mental and physical stimulation, which meets their individual needs. Records of social and therapeutic activities should include the residents’ views on the activity and whether they enjoyed this or were satisfied with the outcome. This will ensure activities offered meet their individual needs. A programme detailing plans for carrying out ongoing maintenance in the home should be devised. This should also include plans for the replacement of worn furniture and carpets. This will ensure that residents are living in a homely, attractive and well-maintained home environment. 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 Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 9 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.V371608.R01.S.doc Version 5.2 Page 10 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, Standard 6 does not apply to this home as people are not admitted for immediate care. Quality in this outcome area is adequate. Information about the home needs to be updated. This will ensure that people have current information about the home. People receive a comprehensive assessment of their care needs to ensure they can be met before admission to the home. This will support people to make an informed decision about whether to stay at the home and agree to the terms and conditions set by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager told us that the Statement of Purpose and Service User Guide have not yet been reviewed. The plan is to review these when they have completed the work required following the last inspection visit earlier this year. Copies of the existing documents are available to residents. One resident spoken with showed us their copy while talking to them in their bedroom. Updated copies of these documents will support people to make an informed decision about whether they move into the home. The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 11 The care files of three residents admitted to the home since our last inspection visit of February 2008 were reviewed through the case tracking process. The pre-admission information for all of these residents was examined. Assessments read provided details of the health and personal care needs of all the three people. Information available includes details of personal care needs, medical history and a record of history of falls mobility. The availability of this information ensures that the specific care needs of each person are identified and used to complete a plan of care. Three residents confirmed that they or a member of their family had been able to visit the home before making the decision to use the home. Both sets of relatives spoken too were aware of the procedures of the Home and had seen and read the Home’s Service User Guide. Residents and relatives confirmed that the Manager had visited them to make an assessment before being offered a place in the home. On the day of the inspection the manager and her deputy had to go out and complete a preplanned pre-admission assessment visit. A resident visited in their bedroom was able to explain the process leading up to their admission to the home. They confirmed that they had been visited by both the manager and the deputy manager. The admission was an emergency. The resident felt that they had been given ‘superb support’ The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. Care plans show good improvement and provide staff with guidance on all aspects of resident’s needs and this should result in appropriate care being given to residents. The medicine management within the home is maintained at a safe level, this supports the safety of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined the care files for four residents. The care plans chosen were for residents requiring varied levels of care. The care plans showed a good level of improvement. The manager and her deputy with the support of staff had worked hard to improve the quality of care plans maintained in the home. Care plans examined show that they had been reviewed and re-written to ensure that they are based on people’s individual assessed needs. Care plans were more detailed, containing sufficient information to give staff clear direction about what they need to do to meet the individual needs of residents. Where generic care plans have been used they contained additional specific The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 13 information which ensured that they reflect the individual needs of each resident. The care plans examined had been written to support nursing and care staff in meeting the residents care needs. Risk assessment had been reviewed and completed in all care plans examined. These include risks related to pressure areas, falls, mobility and nutrition. This gives staff information they need to provide and meet the specific and current care needs of people living in the home. Information available in care plans identified that one of the residents had been assessed as being at risk from falling out of bed. The outcome of the risk assessment showed that the person needed bedrails to maintain their safety. Bed rails were observed in use these were appropriately and safely fitted to ensure the safety of the resident. A further resident had been identified as being at risk of losing weight. Information in a care plan provided staff with clear guidance on how to manage the residents care. Information was recorded to advice staff and the cook on the type of foods that the resident needed to meet their nutritional needs. This information took into consideration the residents likes and dislikes. The care plan contained guidance for staff of when to make a referral to the GP and/or dietician for advice and support in managing this person’s care. Records showed that regular weight checks had been made and recorded. Documenting this information ensures that staff have clear guidance to deliver appropriate care that supports the well being of the person in their care. Written daily reports in care files provided information on people’s day-to-day life in the home and provides details on their health and well being. Entries had been signed, dated and timed by the member of staff making the entries. Entries in the resident health records and comments by people living in the home confirmed that they are supported in getting access to relevant health care professionals when needed. This includes access to GP, Chiropodist, Community Psychiatric Nurse and Optician. Relatives said that “They (Staff) seek medical advice if required” We examined the management of medicines in the home. Medication practices show that there are good systems in place for the ordering, receipt and storage of medicines. Medications received in the home are maintained in the original box and bottles they were received into the home in. Medication is safely stored in locked trolleys, which are kept in locked clinical rooms. Staff record the temperature of the medicines fridge this will ensure the stability of the active ingredients in the medicines ensuring that they are The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 14 suitable for use. Trained nurses are responsible for the administration of medication in the home. An audit of the medication prescribed for people involved in case tracking demonstrated that medicines had been accurately administered as prescribed and medicine administration records were accurately maintained. People living in the home looked clean, well presented and are supported by staff to ensure that their dignity and privacy are maintained. On the day of inspection the hairdresser was visiting the home and residents especially the women were enjoying having their hair done The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 15 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 an 15 Quality in this outcome area is adequate. There is scope to improve social and recreational activities so that the needs of all residents are met. Open visiting arrangements encourage regular contact with relatives and friends. Residents receive wholesome appealing varied meals, which helps to improve their quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care files examined showed that information regarding peoples preferences for their daily routine had been documented, such as their likes and dislikes of different foods. However care files did not contain sufficient information to show the enduring interests and hobbies of individual people. This information could be used to help plan activities and events in the home, which provides physical and mental stimulation for residents. There were no activities seen to take place at the home at the time of the inspection visit. Observations at the inspection showed good interaction between everyone in the home, this includes the interaction between residents and residents and staff and residents. Residents were very social towards each other and residents knew individual staff by name. Some residents were watching the The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 16 Olympics on the television, some were reading, others especially the ladies were having their hair done by the visiting hairdresser. “Residents are encouraged to join in activities but are not made to.” An open visiting policy is practised in the home. This helps to support residents to maintain links with their families and friends. Relatives and friends were seen to visit during the day of inspection. Relatives told us that the home: “Always puts the resident’s first, happy environment, good food.” “Provides…good nutritious food and good atmosphere.” The arrangements at lunchtime were managed better and showed an improvement following the last inspection visit. The dining room was supervised by care staff and staff were observed to be patient and take time to support residents that needed help to eat their meals. Good support was given to residents who were confined to their bed; staff collected one meal at a time based on the resident’s choice from the kitchen. The resident was then fed before a further meal was plated and collected for another resident. This system is good practise and could give staff the opportunity to spend time with people living in the home and also be aware of what the residents have eaten. Snacks were offered to residents during the afternoon of the inspection visit. A choice of ice cream/cornets, crisps, fruit and other snacks were offered. Residents were observed to enjoy the choices offered to them. There was evidence that food from different cultures were offered to residents. There was a sweet potato and papaya, which are provided for residents living in the home who are from the West Indies. The cook told us that other residents have tried these foods. One resident told us that “Afternoon tea is not always served on time.” Staff were seen to start preparing afternoon tea at 5.00 pm for 5.30pm, which staff tell us is about the usually time that residents receive their tea. On the menu for tea that evening was sandwiches or poached egg on toast. The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. People have access to the information they need to complain and know who to talk to if they have any concerns. The adult protection procedure and staff awareness of the procedures reduces the risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is available and displayed in the reception area of the home. A summary of the procedure is included in the Statement of Purpose. Residents and relatives spoken with said that they were aware of how to complain and whom to complain to. Comments made include: “The staff take my comments and observations seriously.” “I have not had to raise any concerns.” Discussions with the manager, information in the AQAA and records examined confirmed that no complaints had been received by the home since the last inspection. Since the last inspection we have received no complaints about the home. The home has an adult protection policy to give staff direction on how to respond to suspicion, allegations or incidences of abuse. Staff have had training in recognising signs and symptoms of abuse. It was evident through discussions with the manager that she is aware of local Social Services and The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 18 Police procedures and her responsibilities for responding to allegations of abuse. Staff were able to confirm that they had attended training related to the protection of vulnerable adults. Staff spoken with were able to explain the action they would take if they saw abuse. Training records examined indicates that protection of vulnerable adults training had been received by staff. There have not been any referrals of adult abuse allegations since the last inspection. The home manager was able to confirm that any allegation of abuse would be notified to us and referred to Social Services for investigation under the local area safeguarding procedures. The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. The environment is varied throughout the home in relation to safety, comfort and hygiene, which might reduce the experience of quality of life for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager and provider told us in their AQAA that the home is decorated and furnished to a high standard. During our visit it was observed that the home is in need of some refurbishment. This is based on the signs of wear and tear to walls, some furniture and carpets. Some bedrooms were visited this includes the bedrooms of people followed through the case tracking process. Some bedrooms were well presented and each bedroom contained resident’s personal items, pictures and small items of furniture. Some effort could be made in ensuring that bed linen is coordinated and laundered so they are not The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 20 so creased before putting on the beds. This would help to improve the presentation of some bedrooms. There have been no changes in the type of baths provided in the home. The baths are dated and are difficult for residents living in the home to use. There is one shower room on the ground floor of the home. This shower is easier for residents to use as it provides level floor access. However, the location of the shower room does not make it easily accessible for all residents. The shower room was clear and not used for storage as noted at the last inspection visit. The maintenance man has started installing ‘Dorguards’ on each resident’s bedroom door. This will allow residents to have their door open, as they wish if the fire alarm is activated the ‘Dorguards’ will be automatically released so that the door closes. There is a well-equipped kitchen and in contrast to the last inspection the cook was organised and the kitchen was clean and tidy. There is a good well organised food store and two freezers and one fridge. Some poor practices were observed, however. One of the freezers was frozen over and temperatures were not consistently recorded to ensure that the contents are maintained at a suitable temperature. This would protect people from the risk of harm. Meat products were not being defrosted on the bottom shelf of the fridge and under this shelf was a carton of milk and a jar of mayonnaise. Records examined related to daily, weekly and monthly cleaning schedules in the kitchen, the records were not easy to read. The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. The people who live in this home can feel assured that the home employs sufficient qualified staff to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager tells us that staffing levels remain under continuous review and the numbers of staff on duty are changed dependent on the needs of residents living in the home. Examination of the home’s duty rotas shows that staff are supplied in sufficient numbers to meet the needs of residents. Examination of four weeks duty rotas showed that consistent staffing levels are maintained in the home. It was evident from the outcomes achieved for residents that there is sufficient staff on duty to meet their needs. Staff spoken to felt that there were sufficient staff available to help them meet the needs of residents. Training records show that fourteen out of 21 (66 ) care staff permanently employed in the home have a qualification in care at NVQ (National Vocational Qualification) level two or above. Information in the AQAA told us that a further three care staff are currently working towards the award. This means that 81 of care staff in the home will be qualified at NVQ level two or above which exceeds the National Minimum Standard for 50 of care staff to have this qualification. This should mean that people are cared for by competent staff. The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 22 The personnel files of five recently staff were examined. Files have been organised to make them more accessible and easier to follow. The files showed that they contained evidence that satisfactory pre-employment checks such as Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (PoVA) had been carried out. Two references were obtained for all staff. However steps were not always taken to ensure that references were being requested from the most suitable person. Ensuring consistent and robust recruitment procedures are followed before staff start working in the home safeguard people living in the home from the risk of abuse. Training records examined identify any gaps in learning. Records examined demonstrate that all staff receive mandatory training in moving and handling, infection control, abuse awareness, fire safety and food hygiene. This should mean that staff are updated in safe working practice. An induction checklist is available this covers health and safety issues such as fire meeting points. Staff spoken with said that they had received an induction period when they first started in the home. Staff told us: “When I started the job I have received all induction and training necessary to know how to do the job properly.” Comments received from residents and relatives include: “The staff are cheerful, friendly and caring.” “Provide more staff, they always look very busy.” “I am pleased with the staff and the care I get.” The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is adequate. The health, safety and well being of people living in the home are not always protected from the risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager and deputy manager were present at the inspection. She has the necessary experience to run the home. The manager has completed the Registered Manager Award. The manager is aware of the individual needs of people living the home. Family members were observed to have a good rapport with family members visiting the home. Residents and relatives told us that the staff are prepared to assist with any situation that arises and give advice. The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 24 There are clear lines of accountability within the home with the deputy manager reporting to the manager. The home has started a staff forum which will ensure that staff have the opportunity to have their say and be involved in any ongoing changes in the home. The home has good support from an administrator who helps in the day to day running of the home. The manager and her deputy showed during the inspection that they are committed to making improvements and since the last inspection visit in February 2008 had taken actions to address all of the issues identified in the last report. The home’s Quality Assurance file contained evidence that management reviews the service provided in the home and identifies areas for improvement. Action plans are developed for making improvements and are reviewed to monitor progress against the objectives set. The manager has told us in the AQAA and at the inspection visit that they have held their first resident/relative forum, which went very well. Residents and relatives are willing to help make changes in the home, which would be of benefit to them. For example reviewing the life history sheets, this should then help the home to support residents to maintain their life long interests. The home is also in the process of completing the ‘Gold Standard Award’ with Warwickshire PCT. When completed this award gives the home an accreditation to show that they have a high standard of procedures in place to support them in giving people who require end stage of life care a high standard of care. The personal monies of people living in the home are kept securely in separate bags and accurate records of income and expenditure are kept. An audit of one resident’s personal monies was found to be correct. Information sent to us in the AQAA tells us that equipment is serviced or tested as recommended by the manufacturer or other regulatory body. Evidence was sampled at random to confirm this. For example, records examined show that the equipment serviced includes hoists, portable electrical appliances and fire equipment. Water temperatures are check and fire alarms are tested weekly. A meeting with the Maintenance manager, one of his assistants and examination of records show that nine Dorgards have now been fitted to resident’s bedroom doors and there is an ongoing programme to install Dorgards to all bedrooms doors. Wheelchairs are stored on first floor by the hairdresser’s room. A monthly Wheelchair maintenance programme is in place. This involves checking footplates, brakes and wheels. The wheelchairs are also cleaned, last checked 23/07/08. A yearly check on wheelchairs is also carried out by ‘Nuneaton wheelchair service’; this was last done on 01/08/08. The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 25 Records were seen to confirm chlorination of the water system; samples were taken from the kitchen, laundry and bedroom en suites. As discussed in the section of this report headed environment some procedures and standards maintained in the kitchen showed poor practice. For example meat products were not being defrosted on the bottom shelf of the fridge and under this shelf were a carton of milk and a jar of mayonnaise. This could lead to the risk of harm to people living in the home due to cross contamination of food. The Warwickshire DS0000004326.V371608.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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 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 3 X 3 X 3 2 The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP26 OP38 Regulation 13 Requirement Procedures must be in place to reduce the risk of infection or cross contamination in the home. This must include: Ensuring the temperatures of the fridges and freezers are consistently and accurately recorded. Ensuring that the freezers are defrosted. This will help to confirm that they are working properly. Ensuring that meat products are defrosted on the bottom shelf of the fridge and no other food products are placed underneath them, which could lead to contamination. Ensuring that records related to daily, weekly and monthly cleaning schedules in the kitchen are easy to read and are completed and signed for as the task is completed. This will ensure the health and wellbeing of people who live in the home. The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 28 Timescale for action 11/08/08 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 Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose and Service User Guide should be updated and available in alternative formats. This will ensure prospective residents have all necessary current information to enable them to make an informed decision about using the home. Residents should be consulted about a programme of activities that takes into account their individual and group needs. This will ensure that appropriate mental and physical stimulation, which meets their individual needs. Records of social and therapeutic activities should include the residents’ views on the activity and whether they enjoyed this or were satisfied with the outcome. This will ensure activities offered meet their individual needs. A programme detailing plans for carrying out ongoing maintenance in the home should be devised. This should also include plans for the replacement of worn furniture and carpets. This will ensure that residents are living in a homely, attractive and well-maintained home environment. 2 OP12 3 OP12 4 OP19 The Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Warwickshire DS0000004326.V371608.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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