Inspection on 24/05/05 for The Warwickshire

This inspection was carried out on 24th May 2005.

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

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

Other inspections for this house

The Warwickshire 11/08/08

The Warwickshire 11/02/08

The Warwickshire 14/08/06

The Warwickshire 01/03/06

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 CV23 9JS Lead Inspector Lesley Beadsworth Unannounced 24 May 2005 09:00 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 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 E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 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 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 M Corby N 46 Category(ies) of OP 46 registration, with number of places The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 25 February 2005 Brief Description of the Service: The Warwickshire Nursing & Residential Home is set in the small village of Thurlaston, near Rugby. The nearest amenities and shops are in the near by village of Dunchurch. The home can be reached via public transport although this is not very regular. The nearest bus stop is approximately ½ mile away, on the main Dunchurch road. The Warwickshire 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 flower beds. The home provides accommodation, with nursing and personal care to frail elderly persons and palliative care to elderly persons over 60 years. The bedroom accommodation is in either single or shared rooms. Several of the rooms are suites that are large enough to accommodate couples and many have ensuite facilities. The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day over a total of ten hours. The inspector looked around most of the home and examined some of the staff records of staff and residents. Seven residents, seven staff and one visitor was spoken with. The deputy manager was present for first part of the inspection, in the absence of the registered manager who was on annual leave. What the service does well: What has improved since the last inspection? What they could do better: Whilst the format for care plans have been re-devised since the last inspection these need further attention to provide the staff with the information they need to know what care each resident requires, and ‘daily’ records need to be completed on a daily basis. The plans need to be kept in a more secure or private location. Assessments need to be kept up to date, including pressure sore risk and nutritional assessments. The number of care staff with NVQ Level 2 or equivalent needs to be increased from the present 37 to a minimum of 50 . The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 6 Staff employed directly from overseas have not had a CRB check and those staff files examined did not contain proof of identity. Regulation 37 notifications relating to incidents that have occurred at the home, other than notifications of death, have not been forwarded to the Commission. The registered provider has not provided evidence that monthly visits and reports in accordance with Regulation 26 of the Care Home Regulations 2001 have been carried out. 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 E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 5 The home ensures that prospective service users and/or their families have the opportunity to assess the suitability of the home before making a choice of home and a trial stay before they make a decision to stay. EVIDENCE: Service users spoken with on the subject said that they or their relative had visited the home before deciding to come to the home. A senior member of nursing staff had also visited them at home or in hospital before this. They were able to confirm that they did not make a final decision to stay until they had been there for a period of time. The deputy manager said that this period was usually for four weeks but that this has been extended on occasion where necessary. The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,9,10,11 Residents are treated with respect and their privacy is also respected. Some completed care plans do not contain up to date information about the individual care needs, which may put the residents at risk. These records are not kept securely, compromising confidentiality of personal information. Some progress has been made in the development of new care plans to ensure that the staff have the information they require to meet the health care and social needs of the residents. EVIDENCE: Residents were seen to be treated with respect by staff and those spoken with confirmed this. Staff knocked on doors before entering the rooms of service users, bathrooms and toilets demonstrating that privacy is respected. The deputy manager showed the inspector the revised version of the care plans for the residents at the Warwickshire. These will be easier to follow and have the potential to be more detailed. Each resident has a care plan but these are kept in holders in the service users’ bedrooms and are therefore not in a secure location. Those examined did not contain current information, in one instance with regard to catheterisation. A member of staff spoken to at the time was unsure of the current needs although was able to obtain this information. Daily records are The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 10 not completed each day, which creates the risk of significant information not being recorded. In addition assessments had not been updated, including pressure sore assessments. There was no evidence found of nutritional assessments having been carried out. An injury sustained by a service user, whilst recorded on her personal file, had not been notified to the Commission. The deputy manager informed the inspector that the care plans have been improved in relation to pain relief/palliative care, but this was not assessed at the time of this inspection. Standard 9 was not fully assessed at this inspection but it was noted that the temperatures of the medical fridge had not been recorded on a daily basis creating a risk of medication being stored at the wrong temperature. The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13, 15 The home has few links with the local community. Visitors are welcomed and are able to visit away from the main sitting areas. Meals are well presented and tasty and nutritionally balanced. The meals are taken in a pleasant environment. EVIDENCE: The inspector joined some of the service users for lunch. The majority took their meal in the pleasant dining room. Staff were in full attendance to serve the meal and to offer assistance as required. This was given in a sensitive and friendly manner and the mealtime was a pleasant experience for the residents. Those spoken with said that they enjoyed the food at The Warwickshire and that there was a good choice of main course and dessert each day. They also said that there are sufficient drinks and snacks served during the day. The catering assistant offered the evening drink to residents on an individual basis. The kitchen was viewed after the evening meal and was clean and in good order. Organised activity was not seen during the inspection but activity equipment was in evidence and individual residents talked of their pastimes of videos and reading. The deputy manager said that there is a designated activity organiser and that residents are taken out individually for walks around the village or to the village church. There are no local shops, post office or pubs but there is involvement with local schools at Harvest Festival and Christmas time to The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 12 maintain some links with the local community. Some trips are organised through the year. Visiting is at any reasonable time and a visitor spoken with at the inspection said that she was made to feel welcome and had spent several hours with her relative that day. Due to the lack of local public transport the home organises a taxi for her from the next village that she pays for herself. The home has an organised system to assist visitors (and staff) to get to and from the home. There are several areas in the home besides their individual bedrooms where residents can entertain their visitors including the reception lounge, the library and the smoking lounge. The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) No Standards were assessed from this section on this occasion. EVIDENCE: The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,25,26 The home is a mainly attractive, apart from the main lounge areas, generally well maintained, clean and comfortable in appearance. There were some minor maintenance repairs required. The Warwickshire is located in a pleasant and quiet location in the middle of the village but shops, public transport and places of entertainment are not easily accessible. The gardens are extensive, very well maintained and accessible to residents. EVIDENCE: The Warwickshire is not ideally located for services such as shops, post offices, public houses or outside entertainment but is set in an otherwise attractive and peaceful location. A maintenance programme was not available at the time of the inspection as the maintenance person was not at the home, but apart from minor problems the home appeared well maintained. These problems included broken bath panels needing repair or replacement, one window restrictor had not been replaced after the window had been painted and repair work was needed to the skirting area of the library. The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 15 A shower room on the ground floor was being used as a storeroom as the deputy manager said that few residents’ preferred to take a shower. There are four other communal bathing facilities and there are 29 rooms with individual or shared ensuite facilities and therefore there are sufficient facilities in use for the residents. Some radiators have radiator guards and these are being provided in a planned programme. Hot water outlets have temperature control valves to prevent accidental burns or scalds, as was required at the last inspection. The dining room is pleasant with attractive tableware and table linen. The reception lounge area, the smoking room and the library are comfortable sitting areas but the main lounge areas are less welcoming and attractive than the rest of the home, appearing cluttered and untidy. The ‘ex-nurses station’ by the lounge is used to store wheelchairs, activity items and other equipment and this adds to the institutional appearance of this part of the home. All lighting in communal areas is domestic in character and of sufficient brightness, and the majority of lighting throughout the home is attractive and of an excellent quality. The home was found to be generally clean and hygienic, with appropriately sited hand-washing facilities. The majority of the home was free of any offensive odour apart from one or two bedrooms that had a faint smell of urine and were identified with the deputy manager at the time of the inspection who immediately asked the domestic staff to clean the carpets of those rooms. The laundry is a good size but appeared disorganised at the time of the inspection said to be due to the unexpected absence of the laundry assistant that morning. The ‘dirty to clean’ system was not clearly defined at this time. Residents have access to all parts of the building by means of ramps, a stairlift and a passenger lift. The passenger lift is very small only just allowing one wheelchair and one other person in at any one time. The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28,29 Less than 50 of the home’s care staff can evidence their competence as a care assistant. Deficiencies in recruitment practice expose residents to the risk of inappropriate staff being recruited. EVIDENCE: The total percentage of 37 of the care staff with NVQ Level 2, or equivalent includes staff from overseas with a qualification equivalent to that of a UK enrolled nurse. The home needs to increase this to a minimum of 50 during this year. Whilst Standard 29 was not fully assessed due to time constraints there were some staff files that did not contain proof of identity. Staff who had come to the home directly from overseas had not had a CRB check. The administrative staff said that they would address this promptly. The registered persons are to confirm that this has happened. All other staff have had a CRB check completed. All Registered Nurses had undergone a check with the Nurses and Midwives Council, which confirms that the nurses are currently registered to practice. The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 36,38 A Quality Assurance audit has not been recorded and Regulation 26 reports have not been provided on a monthly basis, implying that the registered provider does not carry out the required monitoring of the home. Not all staff have received supervision addressing the necessary specifications at the required intervals. The home does not have confirmation that the electrical wiring is satisfactory as has been required at previous inspections. The premises are not secure at all times. EVIDENCE: The deputy manager was able to describe the quality audit of the service carried out by her and the registered manager but none of this, or any action taken as a result, had been recorded. The inspector was therefore unable to assess that this had taken place. Surveys have been sent to service users, relatives and other interested parties in the past but outcomes were not available at this inspection. The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 18 Some progress has been made in the provision of staff supervision but further advice was needed to enable further progress to be made. Visitors are offered a key to the front door of the home, a notice being displayed to this effect in reception, and this enables them to let themselves at any time of the day or night. Whilst this offers convenience to the visitors the home needs to consider the security of the home in such an isolated area. Two of the improvements required for the health and safety and welfare of service users have been met by the fitting of radiator covers to all radiators and temperature control valves to all hot water outlets. The need for work to be carried out as had been identified at the last electrical installation inspection report had not been completed. Accidents and other incidents affecting the welfare of residents have not been reported to the Commission for Social Care Inspection as is required in Regulation 37 of the Care Home Regulations 2001. The registered provider, or his representative, has not provided Regulation 26 reports on a monthly basis. The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 4 COMPLAINTS AND PROTECTION 2 2 3 x x x 3 3 STAFFING Standard No Score 27 x 28 2 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 2 x x 2 x 2 The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15(1) Requirement A service user plan generated from a comprehensive assessment must be drawn up, with the service user and/or their representative and in sufficient detail to ensure that all aspects of the health, personal and social care needs of the service user are met. These must include assessments for pressure sores and nutrition. Records for individual must be maintained on a daily basis. Refrigerators storing mediaction must be maintained at the appropraite temperature which is checked and recorded daily. The maintenance needs identified in the body of this report must be addressed. The registered persons must give consideration to the main lounge areas, including the nurse station, to meet the service users needs in a comfortable and homely way. There must be minimumof 50 of the care staff with NVQ Level 2 Qualification or equivalent. All staff employed at the home Timescale for action 30 June 2005 2. 9 13(2) 30 June 2005 30 June 2005 30 June 2005 3. 4. 19 19,20 23(1)(2) 23(2)(a) 5. 6. 28 29 18(1) 7,9,19 31 December 2005 30 June Page 21 The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 7. 29 Schedule 2 Schedule 2 24(1)(2) (3) 8. 33 9. 38 37(1)(2) 17(1)(a) schedule 3 18 10. 36 11. 38 13(6) 12. 38 13 must have undertaken a CRB check. All staff records must include the information requird in Schedule 2 of the Care Home Regualtions 2001. The registered manager must implement a quality assurance and monitoring system based on seeking the views of service users and to measure the quality of the services at the home. the registered persons must inform the Commission for Social Care Inspection of any incidents as required in Regulation 37 of the Care Home Regulations 2001. Th registered manager must mainatin regular formal supervision at least six times a year with nursing and care staff. The registered personms must give serious consideration to the practice of supplying keys to the front door to visitors. a risk assessment and appropriate action plan must be forwarded to the Commission. The registered person must carry out the work identified in the the last electrical installation inspection report. 2005 30 June 2005 30 June 2005 30 June 2005 30 June 2005 30 June 30 June 2005 13. 38, 25 (a) 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 11 22 Good Practice Recommendations The registered manager should include detailed paliative care procedures in service users care plans. the registered person should consider the repair of the call E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 22 The Warwickshire bell system to enable it to records calls made in order to provide a quality monitor trail. The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Warwickshire E53 S4326 The Warwickshire V230335 240505 stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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