Inspection on 11/07/06 for The Wells Nursing & Residential Home

This inspection was carried out on 11th July 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 Wells Nursing & Residential... 01/05/07

The Wells Nursing & Residential... 15/11/05

The Wells Nursing & Residential... 25/05/05

The Wells Nursing & Residential... 12/01/05

The Wells Nursing & Residential... 01/07/04

The Wells Nursing & Residential... 19/06/03

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Belma

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

CARE HOMES FOR OLDER PEOPLE The Wells Nursing & Residential Home Henton Wells Somerset BA5 1PD Lead Inspector Stephen Humphreys Key Unannounced Inspection 09:30 11th &12th July 2006 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 Wells Nursing & Residential Home DS0000003304.V297131.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 Wells Nursing & Residential Home DS0000003304.V297131.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Wells Nursing & Residential Home Address Henton Wells Somerset BA5 1PD 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) 01749 673865 01749 676878 The Wells Nursing and Residential Home Mrs Rachel Mary Collins Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places The Wells Nursing & Residential Home DS0000003304.V297131.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Elderly persons of either sex, not less than 60 years, who require general nursing care. Four persons of either sex, in the age range of 40-59 years, who require nursing care by reason of physical disablement. Up to ten places for personal care. Date of last inspection 15th November 2005 Brief Description of the Service: The Wells is a Care Home that provides nursing. The service provides nursing and personal care for up to 39 service users. The Wells Nursing Home is situated on the main road through the village of Henton near the City of Wells. The accommodation is on two floors with a passenger lift to the first floor where 25 of the 39 bedrooms are located. All the bedrooms are single occupancy, some with en-suite facilities, which includes a wash hand basin and toilet. On the ground floor there is a lounge, a dining area and a conservatory. There is a garden at the rear of the building with an open outlook and views across to the Mendip Hills. The garden is lawned and flat, the river Axe runs along the bottom of the garden. Laundry processing and all catering are managed in-house. The Wells Nursing & Residential Home DS0000003304.V297131.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 key inspection using the Commission for Social Care Inspection Inspecting for Better Lives methodology. The inspection was unannounced and carried out over two days in July 2006. The inspector was able to meet with the registered provider and registered manager during the inspection and discuss matters of the home. At the time of this inspection there were 38 residents being accommodated in the home. The inspection process involved talking at length to residents, relatives, staff members, observing care practices, reviewing care and administrative records. The inspection methodology used by the Commission for Social Care Inspection enables the inspector to make a judgement on the quality of the service delivery based on the outcomes for residents. Prior to the site visit the inspector sent out a pre-inspection questionnaire for the registered manager to complete and return. Fourteen resident survey forms were sent to a random selection of residents. Comment cards were also sent to visiting GP’s. The results from the satisfaction surveys were very positive from all respondents. Comments from the surveys will be included in the body of the report. The outcome of the discussions with residents and relatives during the site visit was also positive with comments received like,” …very pleasant responsive staff … they always smile”. The outcome of this inspection identified the homes strengths in care delivery, however the inspector discussed with the registered provider the concerns of not meeting two of the requirements made at the last inspection. One requirement was to refurbish the ground floor bathroom, which has not been carried out. The other requirement not met and has not been improved relates to medicine records. What the service does well: The Wells Nursing & Residential Home DS0000003304.V297131.R01.S.doc Version 5.2 Page 6 The registered manager has developed and maintains a high standard of personal and nursing care delivery. The registered manager has a dedicated staff team and leads from the front. All the residents spoken to felt that their individual needs were met. The social activities are planned in advance by the co-ordinator and discussed and agreed at the monthly residents meetings. The standard of record keeping in the home is very good and the administration team provide good customer care service. What has improved since the last inspection? What they could do better: The registered person should ensure that the information made available to prospective residents and visitors is up to date. The registered provider should introduce a planned programme of maintenance for the home including repair and replacement of equipment. The registered provider should review the internal environment of the home and develop the accommodation to meet the requirements of future resident’s, especially residents with complex care needs. Bathing / shower facilities need to be upgraded to meet the older persons national minimum standards. Thermostatic regulator valves need to be fitted to hot water outlets to ensure the safety of the residents from scalding. The registered provider should review the furnishings and fittings through out the home and replace or repair those that are damaged. The care delivery in the home is of a good standard however it is task orientated. The registered manager should move towards more person centred care that enables and supports the resident to be as independent as possible and enables them to make choices with regards to their daily lifestyle. The Wells Nursing & Residential Home DS0000003304.V297131.R01.S.doc Version 5.2 Page 7 The registered manager must ensure that all hand transcribed medicine administration records are witnessed with two signatures. The residents would benefit from more involvement in the social arrangements in the home. Activities records should also document the benefits to residents with a therapeutic outcome. The registered manager could improve the care planning process to include regular review of needs assessments to reflect the current state of the resident. The registered person should introduce a quality assurance system that includes regular clinical and management audits and resident satisfaction surveys. 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 Wells Nursing & Residential Home DS0000003304.V297131.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 Wells Nursing & Residential Home DS0000003304.V297131.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): 1,2,3,4,5 The quality in this outcome group is adequate. Prospective residents or their relatives do not receive up to date information on the homes services in written form. Prospective residents can be assured their nursing and care needs will be identified in a needs based assessment carried out by the registered manager. EVIDENCE: A copy of the statement of purpose or service user guide was not on display in the home. The registered manager had a copy in her office that had been written in 2002. None of the residents spoken to could recall receiving or reading the service user guide, however the results from the residents survey indicated that respondents felt they had sufficient information about the home to make a choice. Many of the residents spoken to said that they were in hospital prior to moving into the home and were not able to visit therefore their relatives chose The Wells Nursing & Residential Home DS0000003304.V297131.R01.S.doc Version 5.2 Page 10 the home for them. Two relatives said that it was the only home with a vacancy at the time. Relatives said that they had heard of the good reputation of the home from friends. Relatives felt that they could make a decision on visiting the home and from the verbal information provided during the visit. To improve the quality of the service written information must be provided to prospective residents or their representatives. The registered person must have an up to date statement of purpose and should make a copy of the service user guide available to prospective residents to enable them to make an informed choice about the home. The inspector reviewed six residents files held by the administrator. Each residents file contained a contract with terms & conditions. The terms & conditions did not make clear the rights and obligations of the registered provider and resident if a breach of contract was made. All contracts contained the room number, fees and description of the care and services provided. Items such as hairdressing and newspapers were identified as extras and not included in the fees payable. The survey respondents and relatives spoken to during the visit confirmed that contracts had been received. The admission of residents to the home is not always based on whether the home can meet the resident’s needs. Evidence of market forces and bed availability was identified and confirmed by comments such as “..it was the only home with a vacancy” and “the social worker put me here” received from residents and relatives. The registered manager carries out a needs based assessment prior to admission on all prospective residents. At the time of this inspection one resident was being transferred to another care home because the registered manager felt that The Wells nursing home could not meet her dementia care needs. The registered manager said the decision was not taken lightly but determined on the lack of the skills and abilities of the staff to care for this resident that had complex care needs associated with her dementia. During the inspection the inspector discussed the care of people with dementia with individual care staff. The level of understanding of the complex needs and how to meet them for people with dementia was very low. There was no evidence of any specific dementia care being delivered to any residents with dementia in the home. The registered manager uses the activities of daily living model of care to carry out the needs based assessment on all prospective residents. The assessment of the residents case tracked was not revisited to reflect current state of physical or mental well being. The Wells Nursing & Residential Home DS0000003304.V297131.R01.S.doc Version 5.2 Page 11 A large proportion of the care staff are from overseas, many have nursing skills and are experienced in delivering nursing care to older persons. Residents spoken to said they felt their care needs were being met fully, this was confirmed by at least three relatives who spoke to the inspector. To ensure the residents nursing and care needs are met the registered manager has introduced a key worker system and the level of staffing has been increased by one in the morning. The Wells Nursing & Residential Home DS0000003304.V297131.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 The quality in this outcome group is adequate. Residents receive nursing and personal care from trained and experienced nurses and carers who are experienced and respectful at all times although the care is task orientated. EVIDENCE: Each resident has a care plan that is detailed and includes all the information to be held on each resident. The care plan includes risk assessments and nursing / personal care interventions. The daily report is completed and dated, however the record does not identify the specific care carried out to meet the care needs of the individual. The daily record identifies “all care given” however there is no evidence to show what care is given in relation to meeting the care needs. There is no record of the progress or regress in meeting the desired resident outcomes. Only one care plan had evidence of relative involvement, there was no evidence to support that any resident was involved in their care plan. None of the residents spoken to could recall being involved or seeing their care plan. The care plans in general are similar and portray task orientated care practices, which is evidenced by the bath rotas and confirmed by residents who The Wells Nursing & Residential Home DS0000003304.V297131.R01.S.doc Version 5.2 Page 13 said they have a bath on specific days only. The social care entries do not identify any benefits or outcomes achieved by the resident. The care plan complies with clinical guidelines however the registered manager is encouraged to make it into a working record and involve the resident in its development. Staff were observed carrying out personal care to residents respectfully and sensitively. Comments received from residents included “ …it can be difficult getting through to some of the foreign staff”……”they are very pleasant and responsive – they always smile”. One relative commented, “We feel that all the staff do their best to keep everyone happy”. There appeared to be adequate pressure relieving equipment through out the home. Four mobile lifting hoists, two assisted baths but the ground floor one was to be decommissioned; sixteen beds had bed rails fitted. Residents are visited as required by the GP, optician, chiropodist and other health care professionals. A professional visitors record is maintained in each care plan. Nutritional screening is recorded along with the need for a special diet. Weight monitoring is carried out monthly. The medication procedure followed by the nursing staff is the Nursing & Midwifery Council standard. The receipt, storage, administration and disposal of medicines were reviewed. The local pharmacist inspected the homes medicine procedures on the 23rd February 2006 and made no requirements. The receipt of medicines is recorded on the medicine administration record. The majority of the prescriptions are produced in type form on the medicine administration record. Two prescriptions were hand transcribed and only had one signature. To prevent any errors the registered manager must ensure all hand transcribed prescriptions have two signatures on the medicine administration record. No errors were found with the controlled drugs procedure. Security and storage of oxygen cylinders was satisfactory. Residents said that staff treat them with respect and dignity is preserved at all times. Staff were observed to knock on doors before entering and speaking politely to residents. Evidence of the gold standards framework (Liverpool pathway) method of care planning was seen being used on very frail residents and residents who have palliative care needs. This method ensures that resident’s wishes at end of life are carried out and respected. The Wells Nursing & Residential Home DS0000003304.V297131.R01.S.doc Version 5.2 Page 14 The registered manager is encouraged to develop this method of care planning through out as this method is holistic and person centred. The Wells Nursing & Residential Home DS0000003304.V297131.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality in this outcome group is adequate. The daily routines are mainly task orientated and do not provide residents with a flexible daily life style. EVIDENCE: The registered manager acknowledges that the rituals and practices in the home especially in the mornings are task orientated. This is mainly due to the dependency of the current residents. During the two-day visit only eight residents were observed to take their lunch in the dining room. Other residents chose to eat in their rooms. Only three people where observed to use the ground floor lounge during the day to watch the television. Other residents preferred to stay in their rooms. Whilst speaking to a resident in their room, an activities plan for the year was observed to be on the dresser however the resident did not appear to know it was there, as it was slightly unsighted from where she sat. On the reverse of the activities programme was the menu. When asked about meals the response was “you eat what they give you”. The resident confirmed relative’s visiting is unrestricted. The Wells Nursing & Residential Home DS0000003304.V297131.R01.S.doc Version 5.2 Page 16 One relative said they spend time providing comfort and support. One resident said, “she felt a lot better for being in the home, she was starting to eat again, staff were very nice and the food was ok”. Another resident confirmed an outing each Sunday to attend church and other outings arranged by the activities co-ordinator to Dunster, Western Super Mear and a mystery tour. “The staff are very good, you want something, you get it”. The inspector observed three residents who preferred to remain in their rooms. Staff only visited them whenever they pressed the call bell. Of the three residents only one preferred to watch a television, no other form of stimulation was provided to them. The staff level is reduced in the afternoon to four carers which does not enable a person centred care culture to develop in the home. The chef in the home is experienced in home cooking. The menus appear to be well balanced. Special diets are prepared and residents requiring pureed meals were assisted by carers in a sensitive manor. Seven residents required a diabetic diet. Lunch was observed on both days. The meals are served by the carers who take the meals to the residents. The geography of the home is such that meals are served from the empty dining room and taken to residents around the home. Meals taken to rooms were covered appropriately. Frail residents had intake and output record charts to record the fluid and food intake. No concerns were heard about the meals, however the registered manager is encouraged as a matter of good practice to ensure the chef involves the residents in the development of the menus. The menu of the day should be displayed in areas of the home where residents can view it. The Wells Nursing & Residential Home DS0000003304.V297131.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): 16,18 The quality in this outcome group is adequate, however the inspector has severe reservations on the quality of training and staff understanding of vulnerable adult issues. Recruitment policies and procedures are in place to protect residents from abuse. Residents can be assured that the registered person will take any concerns or complaints seriously. EVIDENCE: None of the residents or relatives spoken to had any complaints regarding the care service. One comment received on the resident survey form stated, “Most of the complaints are trivial and caused by the differences in language and customs”. All those spoken to said they would take any concerns or complaints to the matron. None of the relatives or two friends of residents spoken to knew they could contact the Commission for Social Care Inspection to make a complaint. A copy of the complaints procedure was displayed in the main entrance to the home, however as identified at the last inspection, the procedure is out of date and contains information that will misdirect the complainant. Both the registered manager and registered provider said they would investigate any complaints and take any complaints seriously, but they do not appear to place any importance on ensuring that residents or relatives are provided with up to date information on policies and procedures in the home The Wells Nursing & Residential Home DS0000003304.V297131.R01.S.doc Version 5.2 Page 18 concerning the protection of vulnerable adults. This is also confirmed as stated in standard one above that the statement of purpose is in need of up dating. Although all the staff spoken to knew what constituted abuse to residents some of the overseas staff were not able to convincingly show an understanding of the procedure they needed to take to report an incident. The home has an abuse policy that is in need of updating to include the procedures adopted by Somerset county council on vulnerable adults. A staff training session on abuse has been arranged in-house for July 2006. The inspector discussed this with the training manager. Concern was fedback to the registered manager because clearly the training manager was not aware of recent vulnerable adult issues or policies. It is recommended that the trainer be offered update training on vulnerable adult issues to ensure effective inhouse training in the future. Staff recruitment and selection is robust. (see Staffing) The Wells Nursing & Residential Home DS0000003304.V297131.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): 19,21,22,23,24,25,26 The quality in this outcome group is adequate. Residents are comfortable in a clean and warm environment. The internal environment lacks investment and would benefit from a planned programme of repair and replacement. EVIDENCE: The Wells nursing home is clean through out. All the residents bedrooms and communal rooms were homely, with personal possessions. The internal door widths are domestic and suffer from the buffeting of wheelchairs and mobile hoists. The corridor carpets are stained but not worn. The registered provider has initiated a regular programme of cleaning of the carpets. The walls and woodwork of the home are in need of repainting and some of the furnishings need replacement especially in the dining rooms. The conservatory woodwork is in need of repair as condensation was apparent on the inside of the windows. The Wells Nursing & Residential Home DS0000003304.V297131.R01.S.doc Version 5.2 Page 20 One member of staff said “they felt embarrassed about the poor fabric of the place”. The ground floor bathroom is not suitable to use and should be decommissioned due to damp and damaged flooring. The toilet room next door smelt of damp. The state of this bathroom was identified at the last inspection and a requirement made to bring it up to meet the national minimum standards, however the registered provider has chosen not to take any action to ensure the residents are bathed in comfort. The inspector had a detailed discussion with the registered provider on this issue who has agreed to decommission the bathroom and refurbish it into a wet room or to up grade it into an assisted bathroom. Generally the pillows are worn and need replacing. Hygiene and infection control procedures were adhered to. Staff were observed to follow the infection control procedures including the handling of infected or foul linen in the laundry. Sluices were clean and no malodours were noted. The Wells Nursing & Residential Home DS0000003304.V297131.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The quality in this outcome group is good. The registered manager ensures the staffing levels are maintained and that the recruitment and selection procedure is robust. EVIDENCE: The staffing level has been increased from four to five carers in the morning. On a daily basis the staffing complement consists of the registered manager and two registered nurse’s plus five carers in the morning and four in the evening. Night staff is one registered nurse and two carers. The staff rotas were checked and found to be correct. Recruitment of overseas staff has enabled the registered manager to maintain a full staffing complement. Recruitment of local staff is proving difficult. Several of the overseas staff are qualified nurses who do not meet the registration requirements for registration in this country and are working as experienced carers. The staff are experienced in caring for older persons and also receive in-house training. There is a staff room that contains resources for training and updating knowledge in health and social care. Six staff files were checked during the inspection. All the staff files are kept securely in the administrator’s office. All the files contained all the required checks and information to meet the national minimum standards. The Wells Nursing & Residential Home DS0000003304.V297131.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 The quality in this outcome group is adequate. Residents can be assured of strong leadership however they cannot be fully assured the home is run in their best interests. EVIDENCE: The home has an experienced Registered Nurse Manager. The residents and relatives spoke highly of the Manager, reflecting on her approachability and kindness. One relative said “Rachel is the one who maintains the standards”. “she knows the residents very well and when you speak to her you get proper answers”. “we are kept informed by staff of any condition changes”. There is administrative support to assist the Manager with contracting and staff recruitment. Residents contracts and personal finances were seen at this inspection and were correct, appropriately stored and with restricted access for security. The Wells Nursing & Residential Home DS0000003304.V297131.R01.S.doc Version 5.2 Page 23 The standard of record keeping by the administrator is excellent however some of the records required to be kept by the registered manager were not up to date. The general policies and procedures are in need of review and up dating. The registered manager has not set up any formal quality assurance system for the home as shown by the out of date policies, lack of formal staff supervision and no resident satisfaction surveys. Staff are supervised in their daily work and regular staff meetings are held for the three groups of staff, care staff, registered nurses and the domestic team, however formal supervision has not yet been fully established and will be monitored at the next inspection. Maintenance and servicing records examined were up to date. One area discussed with the registered provider was in regards to health & safety. The only hot water outlet in the home to have a thermostatic regulator is the assisted bath. It is a requirement to ensure the safety of residents that thermostatic regulator valves are fitted to all hot water outlets where residents can attain full body emersion or at wash hand basins. The regulator valves must ensure the flowing hot water temperature does not exceed 43C. Inspection of the kitchen found the fly-killer in need of emptying and dust had gathered considerably on top of the fridges. Temperature records were satisfactory however the cleanliness of the kitchen was not as good as it should be. The Wells Nursing & Residential Home DS0000003304.V297131.R01.S.doc Version 5.2 Page 24 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 2 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 1 3 3 2 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 2 2 2 The Wells Nursing & Residential Home DS0000003304.V297131.R01.S.doc Version 5.2 Page 25 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 The registered provider must have available for inspection a copy of the statement of purpose. The registered provider must produce a service user guide and make it available to all residents and visitors who request a copy. The registered manager must ensure that the home has the capacity to meet the needs of residents with complex care and nursing needs. MAR charts must be signed by two witness signatures to verify hand transcribed entries. This is outstanding from last inspection. The registered manager must up date the complaints procedure to include the address of the local Commission for Social Care Inspection office. The procedure must also inform complainants their right to take their concerns directly to Commission for Social Care Inspection. The registered manager must ensure through appropriate DS0000003304.V297131.R01.S.doc Timescale for action 30/08/06 2 OP1 5 30/08/06 3 OP4 12(1) 30/08/06 4 OP9 13(2) 30/08/06 5 OP16 22 30/08/06 6 OP18 18 (1) 30/08/06 The Wells Nursing & Residential Home Version 5.2 Page 26 7 8 OP19 23(2)(b) 23(2)(b) OP21 9 10 OP24 OP33 16(2)© 24 (1)(2)(a)( b)(i)(ii)(c) 11 12 OP36 OP37 18(2) 17 13 OP38 13(6) training that all staff are aware of and understand how to report a vulnerable adult incident. The registered provider must develop a programme of routine maintenance in the home . The registered provider must refurbish the ground floor bathroom including replacing the floor covering and treating the damp before it can used for residents. This requirement was not met from the last inspection. The registered provider must provide suitable pillows and bedding to all residents. The registered manager must set up and introduce a system to measure the quality of care in the home. The registered manager must be able to demonstrate through records how the service delivery is meeting the desired outcomes. The registered manager must introduce formal supervision sessions with all staff groups. The registered manager must ensure that all policies and procedures and statutory records are kept up to date in the home. The registered provider must install thermostatic regulator valves to all hot water outlets in rooms used by or for the use of residents. The regulatory valves must be tested monthly and the flowing hot water temperature recorded to be no higher than 43C. The registered manager must ensure the kitchen is cleaned and the fly killer emptied at regular intervals to ensure good hygiene practices. DS0000003304.V297131.R01.S.doc 30/08/06 30/10/06 30/08/06 30/10/08 30/08/06 30/08/06 30/08/06 14 OP38 13(4)© 30/08/06 The Wells Nursing & Residential Home Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP1 OP2 OP7 OP12 OP15 Good Practice Recommendations The registered provider should ensure the statement of purpose is kept up to date and on display in the home. The registered provider should review the terms & conditions to include the rights and obligations of the resident and registered provider. The registered manager should ensure resident involvement in their care plans. The registered manager should review the daily routines of the home to provide flexible person centred care. The registered manager should encourage resident involvement in the development of menus and the daily menu should be displayed in areas of the home for residents to see. The proprietor should give consideration to the general maintenance and upgrading of the premises. Including the repair or replacement of the conservatory. The registered manager should ensure adequate numbers of staff are on duty to meet the social care needs of residents. 5 6 OP19 OP27 The Wells Nursing & Residential Home DS0000003304.V297131.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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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