Inspection on 14/08/06 for The Warwickshire

This inspection was carried out on 14th August 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 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Warwickshire Main Street Thurlaston Rugby Warwickshire CV23 9JS Lead Inspector Jackie Howe Key Unannounced Inspection 14th August 2006 13:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Warwickshire DS0000004326.V300404.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.V300404.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 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.V300404.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st March 2006 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 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 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. Several of the rooms are suites that are large enough to accommodate couples and many have ensuite facilities. Range of fees: £456 - £650 per week. Additional charges are made for hairdressing, private chiropody and other sundries such as newspapers and toiletries. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of the inspection year 2006/07 and was unannounced. It was undertaken over a period of two days. The inspection focused on the outcome for residents of life in the home. The deputy manager was present through out both the days, as the manager was on holiday. The inspector was able to tour the home, and spend time speaking with a number of residents, and five staff. Some comments from people who use the home had been received prior to the inspection, and the manager supplied a completed ‘Provider Information Questionnaire’ (PIQ.) Information from these has been included in the report. There were no visitors available to speak with on the day of the inspection. The inspector ate lunch with the residents and was able to observe care practices, and how staff interacted with residents in the home. During the inspection the care of three residents in particular were examined, including reading their care plans and documentation, observing care offered to them and that staff had the necessary skills to care for them. Records including staff files, policies and procedures, health and safety / environmental checks and risk assessments were also accessed. What the service does well: The home is a very attractive building set in extensive grounds and is full of character. It has large picture windows so that residents are able to enjoy the scenery even if they are unable to get outside, including bedroom windows, which are set at an appropriate height. The home offers a choice of communal spaces, some with televisions some without, and a room for residents who like to smoke. The dining room is well decorated and nicely presented, also with views over the gardens. All residents are issued with a contract with gives sufficient information on the rights and obligations of residents in the home and fees payable. Residents and their families are supported in making bedrooms personal to individual choice. Some of the bedrooms are very large and spacious allowing residents to bring into the home significant furnishings. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 6 The home has a stable group of staff, some of them recruited from overseas, and there is not a need to employ agency staff in the home. Staffing levels are satisfactory, based on the number of residents currently in the home, with a satisfactory level of qualified nursing staff. Meals provided offer residents choice and are varied and nutritious. Special diets are catered for. Residents confirmed that they enjoyed the food. ‘The food is very good indeed’. The home has commenced the NHS ‘Gold standards Framework’ for providing palliative care. What has improved since the last inspection? What they could do better: Information currently available for prospective residents and their relatives to make an informed choice about life in the home, does not fully reflect current practice and should be reviewed and amended as such. Care planning needs to improve to guide staff in how to deliver care to individual residents promoting the dignity and individual needs of the very frail residents in the home. Staff would benefit from more training in care planning, dementia awareness, and in identifying the needs of individuals (person centred care) training. The medicine management requires some improvements to guarantee safe administration. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 7 The home provides only a limited activity programme of events, which is unstructured and does not promote residents leading a lifestyle that fully satisfies their social and recreational needs. The home needs to develop its processes for quality assurance, making sure that residents, relatives and other interested parties are able to comment on the facilities provided. The manager should be able to demonstrate where concerns have been identified, how the home is making improvements if required and then implementing change so that the home is run in the best interests of the residents. There is little evidence available to show what training staff have undertaken, and how this has benefited the staff and the residents living in the home. Recording and systems in the home generally need improving to allow the manager to demonstrate what is being done, how it is achieved and how it is monitored and reviewed. 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.V300404.R01.S.doc Version 5.2 Page 8 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.V300404.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3, 4, 6 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. Information provided by the home to allow potential residents to make an informed choice, requires review to ensure it accurately reflects current practice. All residents are assessed prior to admission, but staff are not always equipped with sufficient skills to care for assessed needs, and this could result in poor care standards. EVIDENCE: The ‘Statement of Purpose’ was reviewed in February 2006 and is detailed giving prospective residents information about the home and its services. Some of the information however is now inaccurate, for example the ‘Statement of Purpose’ states that a residents meeting is held every 3 months with meetings for relatives every 6 months. The deputy manager said this was not the case, and there was no evidence available to show that meetings had taken place. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 10 The Statement of Purpose and Service Users Guide are available for residents to access, with every resident receiving a copy of the Users Guide. Consideration should be given to providing this information in alternative formats, and to reviewing some of the fonts used in the ‘Statement of Purpose’ to ensure they are accessible to as many people as possible. A copy of the contract issued to all residents was read and this meets the required standards, giving information on residents’ rights and obligations, fees, the room to be occupied and period of notice. Admissions are not made to the home until a needs assessment has been undertaken. Where the potential admission has been made through social services care management arrangements, the manager ensures that she has received a summary of the assessment made. For people who are self-funding, the manager or her deputy always undertake an assessment. The pre-admission assessment documents of two residents were read during the inspection. The assessment documents read cover all the aspects required in the standards. During the inspection the deputy manager was heard organising the admission for a new resident the following day. The management team had assessed the resident in hospital, but the family had some anxieties. The deputy manager was heard to speak sympathetically with the relatives, offering them reassurances and was also seen to be organising specialist equipment required. Residents spoken with confirmed that they had been assessed prior to admission in hospital, and had been reassured by the home that they could meet their needs. A number of residents said that they had not had an opportunity to view the home prior to admission as they had come from hospital and had relied on relatives making the decision for them. The care plans of two residents with complex specialist needs, and observed care practices with these residents, showed that staff do not all have the skills and competencies, or knowledge of current good practices required to meet the assessed needs. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. Care plans and care practices are not always adequate and sufficiently reviewed, to guide staff in the care required for individuals to meet their needs, and protect their safety, health and dignity. EVIDENCE: The staff in the home have undertaken some improvement in care planning systems since the last inspection, and have introduced new documents to undertake nutrition screening, and risk assessment to identify and minimise areas of health risk. The documents now in use could be potentially satisfactory to record residents needs, but care plans read were of different quality, both in regard to content, and accuracy. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 12 Some care plans detailed the care required in language that is sensitive to the needs of residents and person centred in approach. Some care plans showed that reviews of care had been undertaken and that staff are aware of changing needs, and the different care approaches required. Other care plans read were limited in the information available, in life history work, and did not show a review of care needs. Records kept regarding whether a resident had received a bath were found to be inaccurate, and other relevant recordings were missing. A resident who is no longer cared for in bed, still had a risk assessment for bed rails. In one care plan there was no clear indication of what staff needed to look out for to be aware of a problem with constipation, records of bowel movements were incomplete and where physical invasive care is needed regularly, nothing was in place to show how the dignity and potential discomfort and fear that the resident may experience could be minimised and protected. The use of safety devises such as bed rails are now being risk assessed, but the manager must ensure that lap straps when used in wheel chairs are also risk assessed, and regularly reviewed and an explanation for the continued use of such devices recorded. The manager must also ensure that residents who are physically frail and of low weight are regularly reviewed and observations recorded, especially where using weighing scales is thought to be difficult. Care plans generally do not reflect the social care needs of the residents in the home and how they could benefit from social activity, for example the inclusion of a physical activity. Generally health care needs are met by a competent group of nurses who ensure that residents are seen by appropriate medical health professionals, and that chiropody, optician, dental services are available. Nurses spoken with felt that the challenging needs of the residents were well met and that they were given an opportunity to update their professional knowledge. Procedures for the safe handling, storage and administration of medication were examined and generally found to be satisfactory. Prescriptions are ordered in 28-day supplies and copies of prescriptions are kept within the Medication Administration Record (MAR) folder. Hand written MAR charts where required are well written, clearly stating the relevant details of the resident, the medicine and dose, but they fail to record the quantities of medicines received into the home so audits cannot demonstrate that the medicines are administered as prescribed. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 13 Medicines requiring refrigeration are stored correctly, and the temperatures are checked and recorded. Some gaps in the records were found, some medicines had not been administered but the reasons for non-administration had not been recorded. One resident who is prescribed a drug ‘ as required’ does not have a clear protocol for when the drug should be given. Bottles of liquid medication should have the date of opening written clearly on the bottle. Systems in use for controlled drugs in the home are satisfactory, with records being maintained in a controlled drugs register. Supplies checked were found to be accurate. During the inspection staff were heard to speak to residents respectfully and the term of address used was appropriate. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. Opportunities for residents to enjoy recreational activities and exercise choice and control are limited. Residents are able to enjoy meals, which are well presented and offer choice and a wholesome, balanced diet. EVIDENCE: Routines and practices in the home are at times rigid and residents spoken with said that staff do not always consult them about their individual preferences and choices, although on the day of the inspection some staff were seen to be offering choice and consulting with residents, and residents confirmed that there was plenty of choice in regard to food provision. Residents spoken with gave examples of having to go to bed earlier than they would prefer, one resident said she thought it was because ‘the nurses go off duty at 8pm’. Another resident said he had to sit in the lounge for periods of time rather than going back to the bedroom because ‘ I’m not allowed to be on my own’. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 15 Residents are not currently consulted in regard to their feelings about living in the home, or if the lifestyle they lead meets their expectations. As previously mentioned residents and relatives meetings have not taken place, although a questionnaire is being devised and it is hoped that this will be available in the near future. Residents spoken with said that they would welcome the opportunity to contribute to a meeting and offer their opinions. Activities available to residents are a little ‘ad hoc’ and there is not currently a structured programme in place. The activities organiser left the home last year, and a new member of staff is attempting to fill this post but requires supervision and guidance into the role. Staff spoken with confirmed that there was no structured programme for activities, and that there were no organised trips out, although there had been occasions in the past when walks to the village pub had taken place. Staff identified that this was an area for improvement in the home. Residents spoken with said that they did participate in some activities such as Bingo, and that they had entertainers on a regular basis, but were unaware of what was available on a day to day basis. There is no information displayed or circulated to residents regarding up and coming events, and the ‘white board’ where part of a programme is displayed, was out of date and not easily accessible. During the inspection some residents were seen to be reading, watching television and playing bingo. Some said that this was sufficient to meet their needs, whilst others said that they would welcome more opportunities try new ideas and to go out. One resident said she missed going into town. There was very little interaction noticed between some members of the staff group and the residents. Staff were noted to sit amongst residents, but were not observed to initiate conversation, or start some simple activity by looking at magazines or pictures, or to make physical contact. Some residents sat in the same place and chair through out the day due to limited independent mobility, with no stimulation. Some residents have expressed a preference to spend the day in their room. Meal provision in the home is good with plenty of choice available. Residents spoken with made positive comments about the food on offer. Comments received included: ‘The food is very good indeed’. ‘I was pleasantly surprised with the quality of the food, there is an excellent choice at breakfast’. ‘You get a choice of between 2 and 3 different things’. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 16 Lunchtime in the dining room was observed, and the inspector ate lunch with the residents. The meal was nicely presented and the meal was served hot and everyone agreed was very tasty. Tables were laid up and presented well, with tablecloths, napkins, good quality cutlery and salt and pepper available. Residents were offered a choice of fruit juice or water to drink. The menu for the day was not displayed in the dining room for anyone to make reference to. Staff served the meal as per the choice made the day before. No one spoken with could remember what the menu was, one resident said that it didn’t matter anyway as ‘you don’t always get what you ask for’. When questioned, the reason for this appears to be a lack of communication between some of the overseas staff whose command of English is not always good, and especially where residents themselves cannot make themselves understood too clearly. The meal was served courteously by staff, who checked that residents were able to manage and offered gentle prompts to those who needed assistance. The majority of residents who required assistance were not seated in the dining room and so their meal service was not observed. The home provides special diets to those that require them, and there was evidence in the kitchen and on the menu of provision for residents who require a diabetic diet. The Warwickshire DS0000004326.V300404.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. The home has a complaints procedure, and complaints are acted upon. Policies and procedures and risk assessments require development to ensure that all residents are protected from potential abuse. EVIDENCE: The home has a complaints procedure, which is displayed and available in the Users Guide. Residents spoken with confirmed that they had seen a copy of the complaints procedure and would know how to complain if they needed to do so. One resident spoken with said that he did not like to ‘make a fuss’ and although had some concerns from time to time would prefer not to say anything. The home now has a system for recording complaints made. Staff spoken with confirmed that they knew about the policy and how to respond to anyone making a complaint, but there is no formal system for staff to record and report these, and the majority of complaints made are passed on verbally to the management team or nurse in charge. Records kept do not currently show how/ if complaints have been investigated or responded to within the agreed timescales, nor do they record if a complaint has been upheld. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 18 Staff confirmed that the home is keen to promote advocacy services, and is happy to access these on residents’ behalf, particularly where finances are involved. The home has in place policies and procedures for the Protection of Vulnerable Adults (POVA), to protect residents from potential abuse. Staff spoken with were aware of the procedures and of the policy for ‘whistle blowing’. Managers in the home are aware of procedures to follow in the result of a POVA referral, and have in the past responded correctly to concerns. The home would benefit from a copy of the Warwickshire multi agency policy which explains the role of social services and the police, and the Department of Health ‘No Secrets ‘document. The manager has recently purchased a training video for staff, to ensure that all staff are fully aware of all the signs and symptoms of all kinds of abuse. Staff spoken with have not yet seen the video, but this is planned for the near future. Some procedures within the home need to be reviewed, to ensure that residents are fully protected. When any resident is subject to a form of restraint, a risk assessment must be undertaken and placed in the care plan to ensure that the welfare of the resident is secured. The risk assessment must be regularly reviewed and reasons for continued use of restraint recorded. The Warwickshire DS0000004326.V300404.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, 26 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the home. The home offers residents a comfortable homely environment, which is fairly well maintained both indoors and outdoors, and personal rooms suit their needs. Safe storage of equipment is an area of concern. EVIDENCE: As previously mentioned, the home is a very attractive building set in extensive grounds and is full of character. The grounds are well maintained and are attractive with a number of flowering shrubs and trees. There are a number of pathways, but some of these are not accessible to wheelchair users. There is seating provided outside and this was seen to be of good sturdy quality with sun protection in the form of large umbrellas. Residents spoke very positively about the gardens and how they enjoyed the views over the grounds and surrounding fields. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 20 The home has large picture windows so that residents are able to enjoy the scenery even if they are unable to get outside, including bedroom windows, which are set at an appropriate height. The home has a full time maintenance person on site, who looks after any dayto-day maintenance needs, and redecoration as required. Some areas of the home are looking a little dated, and some redecoration is required where repairs and alterations have been made. Fire and environmental health inspections have taken place this year and reports were available for inspection. The fire officer reported that the use of door wedges should cease. Door wedges were also observed on the day of the inspection. This was an area of concern raised at the last inspection and the home has purchased new electronic fire safety devises, but more are required to be fitted. The environmental health inspection, which took place in January, was positive and the home was recommended for a ‘gold rating’. On the day of the inspection the kitchen was found to be clean and tidy. The home has schedules to ensure that all areas of the kitchen are regularly cleaned, including some steam cleaning which takes place twice a year. There were no records displayed to demonstrate the checking of freezer and fridge temperatures, and there was opened food stored in the fridge, which was covered but not suitably labelled and dated. Hand washing facilities are provided for staff. The new caterer has been in post for a few weeks and demonstrated that she is aware of the systems required. The home offers a choice of communal spaces, some with televisions some without, and a room for residents who like to smoke. The dining room is well decorated and nicely presented, also with views over the gardens. Lighting in the home is generally satisfactory, although corridors were a little dark when the lights were not left on. Furnishings seen were found to be suitable and in sufficient number for residents in the home. Storage in the home is an area of concern. The home has a considerable number of wheel chairs, lifting equipment and a selection of walking aids, some of which are not in use in the day, or no longer required. The hairdressers’ room is used to store wheel chairs, but when she is using the room, the chairs are left in the lounges and corridors. This is a potential safety hazard and the manager should explore alternative storage space as well as undertake a review of the number of chairs required. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 21 Personal rooms seen were found to be of good size and contained furnishings suitable for their needs. Not all rooms have furniture with a lockable drawer, but the deputy manager said this could be supplied as required. Residents are supplied with specialist equipment to meet their nursing needs as it is required. Residents spoken with said that they were happy with their rooms, and able to furnish them with their own personal possessions as required. One resident spoken with said she had not been offered a key to her room. The home has a thorough infection control policy and the manager and her deputy have both attended an external course and attended updates. The home has sluices available. On the day of the inspection a sluice was found to contain cleaning chemicals and substances and the door to the sluice was open with out lockable facilities. This is a potential risk to resident safety and should either be fitted with a lock, or key pad or have a lockable cupboard. Generally the home was seen to be clean. Some odours were noticed especially around some of the bedroom areas and outside the sluices. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. Staffing levels in the home are satisfactory, but training records and some recruitment practices are not sufficiently robust for the manager to demonstrate that all staff have the required skills and competencies. EVIDENCE: Staffing numbers, and mix of qualified nursing and non-qualified staff in the home were found to be satisfactory, to meet residents’ needs. The manager is full time and she is supported by a deputy who normally has an average of 1 – 2 shifts per week ‘off rota’. The home has a team of regular nursing staff and carers and has not had to employ agency staff. The usual staffing pattern is three nurses plus six care staff on the morning shift of 8am – 4pm and two nurses and four carers in the evening, dropping to four staff at 8pm. Care staff are supported by domestic and laundry assistants, catering staff and kitchen assistants. Administration staff are available Monday to Friday, as well as maintenance, a gardener and driver. Rotas were checked during the inspection and found to reflect adequate staffing levels both day and night. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 23 The home currently employs a number of staff from overseas. The majority of these staff are employed as senior carers, but are qualified nurses in their own country, but not registered to work as such in the UK. Their training has been assessed as being equivalent to a National Vocational Qualification (NVQ) level 3 in care. Apart from these staff, there are currently no staff with an NVQ employed in the home, and the deputy manager said that there was reluctance generally from staff to attend NVQ training. A discussion was held with the deputy manager about the requirement of the organisation to encourage and support staff in attaining NVQ. One member of staff spoken with said this was now an area of training she would like to pursue. Some residents spoken with were positive about the care received in the home particularly from the nursing staff who they said were competent and treated them kindly and were ‘ very attentive’. Some comments received were not so positive, and some residents made comments about and gave examples of staff attitudes, which they did not find always to be helpful or make them feel comfortable. One area of concern raised by a number of residents, is that staff often speak together in a language that they do not understand which leaves them feeling isolated. This was raised with the deputy manager during the inspection, who confirmed that she was aware that this had been a problem in the past but she felt she had addressed this with some staff, and that the practice had stopped. Residents spoken with, and practices observed showed that this is not the case. The manager and senior staff in the home need to provide a level of both formal and informal supervision with staff to address bad practice. The files of four members of staff were read during the inspection, two for training records and two for evidence that correct and robust recruitment practices are undertaken. Files checked for recruitment were generally found to be satisfactory and police checks and confirmation that staff are not on the Protection of Vulnerable Adult (POVA) register, are undertaken within the correct timescales. Records confirm that references had been requested, but on one file there was only evidence of one written reference. A verbal reference had been attained from a previous employer, but there was no record as to the content of the reference. There is no evidence of what actions have been undertaken by the manager, where entries, which may identify a risk, are found on Criminal Record Bureau (CRB) disclosure records, and appointments are subsequently made. The recruitment procedure must state what safeguards are in place to show that staff are suitable to work with vulnerable people. The manager at interview does ask that new staff indicate if there may be an entry on the disclosure, and staff are asked to sign a disclaimer which if found to be incorrect, they are not employed. This is viewed as good practice by the home. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 24 Staff spoken with confirmed that they had attended a number of training courses, the majority of them ‘in house’, and provided by the manager. The files of two staff employed since 2000, and 2002 were checked, and there was evidence that staff had attended regular fire safety lectures and drills, and training in manual handling and some training in wound management and promoting continence. The deputy manager said that staff had attended training in Health and Safety, Basic Food Hygiene and Infection Control, but there was no evidence to this effect, or that staff had been trained in other mandatory courses such as First Aid or Control of Substances Hazardous to Health (COSHH) or in courses regarding specific conditions common to old age, such as falls prevention, Parkinson’s disease and diabetes. Staff do not currently have a personal development file linked to supervision which would identify areas for personal development and further training as required. The home has a number of very frail residents with challenging health needs, and the manager must be able to demonstrate to interested parties that the staff have the required skills to meet those needs. Some staff have watched the new training CD’s on ‘Understanding the needs of people with dementia’. New staff are inducted into the home, a checklist process is followed and staff are given a period of time to be supernumerary to the rota, and are mentored by senior staff and nursing staff. The home would benefit from linking their induction training to the standards in the ‘TOPSS’ induction scheme, which would ensure that staff are covering all the elements required in the standards. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. The manager is experienced and of good character. Recording and management systems in the home, do not allow the manager to demonstrate what is being done, how it is achieved and how it is monitored and reviewed. EVIDENCE: The registered manager has been in post for a number of years and is a qualified nurse. She is experienced in the care of the elderly. Staff spoken with said that they found the manager and the management team to be approachable and that there was a good working atmosphere. ‘ I like working here, it’s a good home with a nice atmosphere’. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 26 Staff confirmed that there were sometimes issues within the staff group, but these were discussed with the manager and sorted appropriately. The management team and registered provider do not have in place an effective quality assurance monitoring system, or any means to self-audit, to seek the views of residents living in the home. The home does not have an annual development plan linked to opinions, or a system, which constantly reviews the outcomes for people using the home, and publishes the actions being taken to respond to comments made. There is also nothing currently in place to show that opinions of relatives visitors or health care professionals such as GP’s, is sought on how the home is responding to residents’ needs. Staff said that a form of questionnaire is being devised, but had no detailed information available, or information on how the results of a questionnaire would be made available to interested parties. The home currently has no way to demonstrate that it is being run in the best interests of the residents. As previously mentioned residents spoken with, said that they would welcome an opportunity to contribute ideas and suggestions and give feedback on the services provided. Systems for the safe keeping of monies to safeguard residents’ financial interests are good. Advocacy services are used for a number of residents where requested or where it is thought to be of benefit to residents. Records seen are appropriate and receipts and written records of transactions are kept. The manager since the last inspection has introduced a new system for staff supervision. Records seen showed that nine members of staff have had a preliminary discussion with the manager to introduce the supervision process, but more needs to be done to show that staff are being regularly supervised both in their day to day roles and in regard to their personal development. The manager must ensure that training and ongoing supervision is in place for staff, to enable her to feel confident that staff are able to fully meet the needs of all residents admitted to the home. Staff spoken with said that they met regularly with the manager but this was on a more informal basis and nothing was recorded. Recording generally within the home is poor and some residents spoken with were unaware of the fact that records such as care plans were maintained, or that they had access to them. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 27 Systems regarding the health and safety of the building are well kept by the maintenance department, and records checked confirmed that safety checks in relation to maintenance of electrical equipment, portable appliance testing, water temperatures and maintenance of lifts and hoists have been undertaken as required. Some health and safety requirements are needed in respect to: • • • • • • The use of door wedges to hold open doors. The storage of wheel chairs and other equipment. Locks are required on all doors that store chemicals. Food stored in the fridge must be labelled and dated. Risk assessments as identified in the report. Induction and training in all areas related to health and safety, and records to be made available of attendance. These were all discussed with the deputy manager at the inspection, who demonstrated a positive response to actively dealing with the requirements made. The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 28 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 3 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 3 x x x 3 x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 1 x 3 1 x 2 The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 4 Requirement Timescale for action 31/10/06 2. OP4 12, 18 3. OP7 15 4. OP9 13(2) The registered manager must ensure that all information in the ‘Statement of Purpose’ is a true reflection of the services provided in the home. The registered manager must 31/10/06 ensure that at all times suitably qualified, competent and experienced staff are working at the home. A service user plan generated 31/10/06 from a comprehensive assessment must be drawn up with the resident 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. (Previous time scale not met) The quantities of all medicines 30/09/06 received and balances carried over from previous cycles must be recorded to enable audits to be undertaken to demonstrate staff competence in medicine management The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 30 5. OP9 13(2) 6. OP9 13(6) 7. OP9 13(2) 8. OP16 17 9. OP18 13 Medicine prescribed for occasional use must be administered against a specific protocol clearly indicating its use and frequency and this must be clearly recorded. Staff drug audits before and after a medicine round must be undertaken on a regular basis to assess nursing staff competence in medicine management and appropriate action must be taken when audits identify that the medicines are not administered as prescribed. All nursing staff must refer to the Medicines Administration Record (MAR) chart before the administration of medicines and directly sign following the transaction or record the reasons for non-administration. The MAR chart must accurately reflect what has been administered within the home. The registered manager must ensure that all information related to complaints received by the home, and the actions taken in response, are recorded. (Requirement not fully met) The registered manager must ensure that on any occasion when a resident is subject to a form of physical restraint, a record of the circumstances, including the nature of the restraint is maintained. 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 10. OP29 19 The registered manager must review the current recruitment DS0000004326.V300404.R01.S.doc 30/11/06 The Warwickshire Version 5.2 Page 31 11. OP29 19 12. OP30 18 13. OP33 24 14. OP36 18 15. OP38 13, 23 16. OP38 13, 23 policy to demonstrate how risks identified in the outcome of Criminal Records Bureau checks are responded to, to ensure the safety of vulnerable adults. The manager must ensure that two written references are received relating to all new employees, and that the content of verbal references is recorded. The registered manager must ensure that all staff attend regular training appropriate to their work, and that detailed records are maintained of such training and are available for inspection. (Requirement not met) The registered manager must ensure that a system is introduced to review and improve the quality of the services offered by the home. The results of an audit undertaken must be forwarded to the commission. The registered manager must ensure that all care staff receive formal supervision six times per year. (Previous time scales not met). A lock must be fitted on the sluice door where chemicals and cleaning products are stored, to minimise the present risk to residents in the home. The registered manager must ensure that the practice of wedging open bedroom doors is stopped and appropriate fire safety device are fitted. 30/09/06 31/10/06 31/12/06 31/10/06 15/09/06 30/09/06 The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 32 17. OP38 13, 23 18. OP38 13 Safe storage must be identified for wheelchairs and other equipment in the home, so that passageways and corridors are not blocked or present a potential risk to residents, visitors and staff. The registered manager must ensure that opened food stored in the fridge is suitably labelled and dated. 31/10/06 30/09/06 The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 33 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 OP1 OP18 Good Practice Recommendations The inspector recommends that font sizes and formats be reviewed for all documents and notices for residents in the home, to make them accessible to all. The inspector recommends that the home obtains a copy of the DoH ‘No Secrets’ document and a copy of the Warwickshire multi agency policy for responding to abuse, and that all staff are made aware of these documents. The inspector recommends that the manager introduce a training matrix to clearly identify where training has been attended by each individual member of staff, and where refresher courses are required. 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 the induction scheme for all new staff employed to the home is linked to the National Occupational Standards ‘TOPSS’ training scheme to ensure that all the required standards are covered in induction. 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. 3. OP30 4. 5. OP30 OP30 6. OP38 The Warwickshire DS0000004326.V300404.R01.S.doc Version 5.2 Page 34 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. 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