Inspection on 01/04/08 for The Wight House Care Home

This inspection was carried out on 1st April 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Wight House Care Home 05/08/09

The Wight House Care Home 24/02/09

The Wight House Care Home 25/09/08

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE The Wight House Care Home 138 Portsmouth Road Lee on the Solent Hampshire PO13 9AE Lead Inspector Pat Trim Unannounced Inspection 1st April 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Wight House Care Home DS0000070368.V361324.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 Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Wight House Care Home Address 138 Portsmouth Road Lee on the Solent Hampshire PO13 9AE 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) 02392 552291 Wight House Care Ltd Post Vacant Care Home 12 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0), Old age, not of places falling within any other category (0) The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 12. Date of last inspection N/A Brief Description of the Service: The Wight House was an existing service purchased by and registered to new providers on 2nd October 2007. The home provides care and accommodation to 12 older persons who may have dementia or mental health needs. Accommodation comprises 10 bedrooms on two floors. Two rooms are capable of accommodating 2 people who use services, but these are predominantly used as single rooms unless people express a wish to share. There is a stair lift to help people reach the first floor but there are a number of areas that need people to be able to walk up a few steps. Three bedrooms are located on the ground floor. There is a communal lounge and dining room on the ground floor and a small quiet room on the first floor. There is a small garden and patio area. The home is situated very near the seafront, with views of the sea. Local shops and amenities are a short walk away. The current fees for the home are from £438.03 to £616.39 per week. Items not covered by the fee include personal toiletries, newspapers, hairdressing and chiropody. The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means people who use this service experience poor quality outcomes. This report summarises information about the service since it was registered on 2nd October 2007. The information used to write this report was obtained in the following ways. We looked to see if we had received any complaints about the home and saw that we had not. We also looked at any information the home had given us about what might have happened since we visited. We used some of the information the acting manager gave us about the home in a form called the Annual Quality Assurance Assessment (AQAA). This is a form the home has to fill out every year to tell us what they are doing to make sure the home gives the people who have used the service the care that they want. Information from four surveys returned to us from people who use the service and their families. The providers were given a courtesy call prior to the visit to inform them it would be made on 1st April 2008. This was because the home did not currently have a registered manager and we had information that the acting manager would not be in the home on that day. This gave the area manager the opportunity to travel from the North to be present during the visit. The visit was carried out by one inspector and lasted six hours. During the visit time was spent talking with five of the people who use the service to get their views about it and four of the staff who worked in the home. Time was also spent discussing the new provider’s plans for the home with the area manager and looking at the environment. Four people who use the service were case tracked. This means their records were looked at to see what their experience of moving into the home had been. Nine requirements were made following this inspection to address shortfalls in meeting the minimum standards. What the service does well: The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 6 People who use the service said they liked living in the home and thought they were well looked after. They liked their rooms and were glad they did not have to share with anyone. They felt they were able to make choices about what time they got up, went to bed and spent their time. They said the meals provided were good and there was plenty to eat. Families felt their relatives were well cared for. Feedback from three relatives included comments such as: ‘I commend all the staff for their attentive and caring manner.’ ‘We are very happy with the running of the care home.’ ‘The staff look after my mother extremely well and she frequently comments on how comfortable and content she feels.’ The Wight House provides care to a maximum of only twelve people and has a very homely feel to it. People are able to move freely around it and spend time with others or in their own rooms if they wish to. There is a small staff team who get to know the people who use the service very well and have a good knowledge of the help they need. Health care needs are monitored well. People are able to see their doctors when they need to and have access to health care services. What has improved since the last inspection? What they could do better: The new providers have not spent time monitoring the home and the lack of a registered manager to direct the day-to-day running has had a detrimental effect on the service provided. The acting manager has tried to manage the home but does not have designated management hours or the ongoing support she needs to enable her to do so. The staff spend a lot of time completing a list of tasks and feel they are not encouraged to spend time socialising with the people who live in the home. There is very little mental stimulation provided and the people who use the service are left to find their own entertainment. The information gathered about people who wish to move into the home is very brief and does not enable the manager to be sure the home will be able to meet the needs of the person. There is no information about what someone can do for themselves. The lack of information means the care plans do not show how staff support people to remain as independent as possible. People The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 7 who use the service are not involved in writing down how they want to be helped to receive personal care. Some staff give out medication but have not had any proper training about how to do this and have not been assessed by the manager as competent to do so. The current method of returning unused medication to the pharmacist is unsafe and medication is not stored safely. There is no staff training programme so it is not possible to monitor when refresher training is needed or to arrange this in good time. The home is showing signs of wear and tear and needs a renovation programme that includes a lot of minor cosmetic repairs and redecoration. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Wight House Care Home DS0000070368.V361324.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 Wight House Care Home DS0000070368.V361324.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Information available to people wishing to use the service is out of date and does not enable them to make an informed choice about whether to move into the home. Assessments need to be more comprehensive if people who wish to use the service are to be confident they will only be offered a place if their needs can be met. EVIDENCE: The organisation had submitted an updated statement of purpose as part of their registration application, but the one in the home had not been changed to reflect the changes in ownership and management. The area manager said it would shortly be reviewed and amended to make sure people were given up to date and accurate information about the home and the AQAA identified the provision of improved written information given to people who use the service as an objective. The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 10 The AQAA stated that everyone wishing to move into the home had to have a detailed assessment of need completed before they were offered a place. The statement of purpose said everyone had to have an assessment, would be visited by a member of the management team to discuss their needs, would be encouraged to visit the home and have a trial period of one month before the placement was made permanent. The files of four residents were viewed to look at their experience of moving into the home. Three of these people had moved to the home before the new providers had taken over. All had brief assessments completed before they moved in. These highlighted areas where someone might need assistance, but gave no information about what someone could and could not do. The previous manager had visited the prospective residents to discuss their needs and complete the assessment before they moved into the home. There was no evidence the assessment process had changed since the new providers took over. The assessment for the fourth person, who had only recently moved into the home, had been completed by the manager of the person’s previous care home and there was no evidence that the acting manager of the Wight House had visited the person or discussed their needs prior to their admission. There was nothing recorded about individual daily routines such as what time someone liked to get up or go to bed. There was some information about their likes and dislikes in respect of food and some of their health care needs, such as whether someone had diabetes. There was a tool for assessing individual mental health needs, but this was not being completed correctly and gave very limited guidance on how to support the person. For example, one recorded that when the person became agitated staff should follow the guidance given by the community psychiatric nurse. There was no information as to what this guidance was. The Wight House Care Home DS0000070368.V361324.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans lack sufficient detail to ensure that people who use the service will consistently receive their care in the way they like it. Current practice in respect of training and assessing staff competency and the disposal of unused medication needs to be reviewed if the risk to people who use the service is to be minimised and medication managed safely. The privacy and dignity of people who use services are compromised by the way confidential information is being recorded. EVIDENCE: Three of the four people who were case tracked had a care plan, but this gave very little information about the person’s abilities and needs. The previous manager had completed these plans, before the current providers took over the home. The file for the forth person, who had only just moved into the home contained no information about what help they needed, other than the brief assessment already referred to in this report. The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 12 Plans described the support people needed in very general terms, such as needs help with washing and dressing or does not need help with dressing. There was no evidence that people who lived in the home had been involved in planning their care. The AQAA identified the need to involve people who use services in care planning as an objective, but stated that comprehensive care plans are completed. Risk assessments were completed for moving and handling. The system used was based on ‘traffic lights’ which showed no assistance needed as ‘green’ to needing the help of two people ‘red’ in a number of different situations such as rolling over in bed, sitting or standing. There was also some guidance as to whether the bath hoist needed to be used to assist people in and out of the bath. Care plans were being reviewed using assessment tools to monitor activities of daily living, tissue viability and mobility on a monthly basis. However, this information was no longer being used to amend and change the care plans. For example, one assessment showed someone needed more support in washing and dressing. The care plan recorded no change to identified needs. The majority of people currently using the service are quite able and require limited assistance with personal care. Five people spoken with during the inspection felt they were well supported by staff. Also, staff were able to demonstrate they had a good knowledge of each individual’s needs and abilities. For example, one member of staff was able to describe how she gave care to one person in a way that supported her to do what she could for herself. The care staff said she ran a bowl of hot water for the person and encouraged her to wash her hands. She also said the person liked to make her bed after the staff had helped her get washed and dressed. None of this was recorded in the care plan. Staff said they got their information from the daily records, daily handovers and, when new, by shadowing experienced staff. However, the AQAA recorded that two of the people living in the home have dementia and they could find it increasingly difficult to express their needs. Also staff said they do sometimes use agency staff, although the AQAA did not record any had been used in the past three months. Comprehensive care plans are needed to ensure all staff have the guidance they need to consistently give care in the way people wish to receive it. The health care needs of people were well managed. Feedback from five people who use the service showed they felt they could see their doctor when they wished. Daily records showed that a doctor had been called when staff had concerns about people who use the service and appropriate referrals made The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 13 to the community psychiatric nurse. People who use the service said they were able to see the chiropodist regularly and daily records evidenced this. Feedback from two health care professionals provided evidence that the health care needs of people who used the service were generally well managed. One health care professional commented ‘the home alerts our service appropriately.’ However, another health care professional had concerns that the staff did not always have the right skills and experience to support ‘individuals with complex medical problems and medication’. The AQAA did not record whether there was a medication policy and procedure or whether it had been recently reviewed. The area manager said the providers had not yet reviewed policies and procedures within the home. Staff said the majority of them had completed medication training some time ago but had not had refresher training. One staff had done a course, whilst others had attended a training day. Training records seen confirmed this. Not all the staff who gave medication had received training. Instead they had been shown what to do by staff who had received training. There was no record that this member of staff had been assessed as competent to give out medication. Medication is delivered to the home in a monitored dosage system every week. One of the care staff explained that the quantity delivered was checked and recorded on the medication administration record. This was seen for the current week’s medication. The area manager said the acting manager put unused tablets back into the monitored dosage system and taped them in place. One of the care staff confirmed this, but neither of them knew if there was a record kept of medication returned to the pharmacist. The medication administration records were viewed. The record for the morning and lunchtime doses had been completed. The member of staff responsible for giving out medication that day stated she always signed the record as she gave each person their medication. The medication for one of the people being case tracked was checked. The amount remaining in the monitored dosage system was correct when checked against the administration record. The home had a cupboard for storing medication, which was not of the standard now required for care homes. There was a lockable box for storing controlled drugs and a book for recording supplies. The AQAA stated the home was not storing any controlled drugs and a member of staff confirmed this. Various creams were found in the communal bathroom. A care staff explained these had belonged to someone no longer in the home and were kept there for anyone to use. This should not be done as unused medication should be The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 14 returned to the pharmacist and creams used in this way could be a source of infection. The area manager removed them. The AQAA stated that there was an assessment for people who wished to self medicate. A member of staff said no one currently self-medicated, although one person was supported to manage one aspect independently. The AQAA recorded that ‘staff are fully aware respect to residents ensuring privacy and dignity is always protected, and gave as evidence that care plans included beliefs and practices. The statement of purpose said people who used services could attend religious services within or outside the home. Staff said the home used to be visited by a local minister but were not sure why this had stopped. Some of the people living in the home said they chose not to attend services and did not mind that a minister did not visit the home. Feedback from five of the people living in the home showed they thought the staff treated them with respect. Comments included ‘the staff are easy to talk to’ and ‘they look after us very well.’ Five of the fifteen staff have completed their National Vocational Qualification (NVQ) which includes looking at core values such as privacy and dignity. People using the service confirmed they could lock their doors if they wished, but they did not have lockable storage space in their rooms for personal items. Privacy, dignity and confidentiality were also compromised by the practice of keeping a communal record of individual bodily functions or when someone had a bath. Staff could give no reason for these records except they ‘had always been done that way.’ The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use services are able to make some choices about how they spend their time. Practice in the home is task orientated so people who use the service are not able to enjoy social interaction with staff unless they are providing care. There are very few activities provided that people who use the service like to do and that provide mental stimulation. Residents are offered a well balanced diet with meals they enjoy but would benefit from having a choice of main meal. EVIDENCE: Of the five people spoken with, only one required assistance with washing and dressing. The others were independent and required little assistance with personal care. They felt they were able to make choices about their daily routines and could get up and go to bed when they wished. They said they normally had breakfast in their rooms before they got up, but could have breakfast downstairs if they wished. One person using the service was seen to be having breakfast at the dining room table. When asked how they spent their time, people who use the service said they mainly chatted to each other or watched television. Some of them said they The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 16 liked to go for short walks, either in the garden or along the road. One or two liked to knit or read and some had daily papers delivered. People said they spent time in the communal areas and in their rooms. Several chose to have their meals in their rooms and their wishes were accommodated. People who use the service said someone came to the home each month to provide ‘Music for Health’ and records confirmed a visit had been arranged for April. People spoken with seemed generally satisfied with what was provided, although they said they would like outings arranged. A copy of staff daily and weekly tasks was pinned in the kitchen. This showed that staff spent a lot of time cleaning and completing chores. Those spoken to felt they were not encouraged to spend time talking with people who use the service. Many of the staff have worked at the home a long time but felt that the current staffing arrangements did not enable them to spend time with the people who used services like they used to. Two staff commented that they used to take people living in the home out for walks or picnics on the beach but did not find it easy to do this now. People who use the service were seen chatting to staff when they were in the lounge or dining room. However, they commented that staff were always so busy, there was not much time to talk. The statement of purpose and service user guide said that it ‘offered a wide range of activities designed to encourage the client to keep mobile and most importantly take an interest in life.’ A list of activities included ‘helping choose library books’ but staff said the mobile library no longer visited the home. It also included ‘manicures’ but staff described one of their tasks as having to cut everyone’s nails. Staff explained this did not include filing or painting female residents’ nails. The AQAA recorded that following a request from the people living in the home a number of board games had been purchased and that they were encouraged to play them. There was no evidence to support this statement. People living in the home are not encouraged or supported to help with daily routines. Although one person is helped to make their bed by one member of staff, another is no longer allowed to fold napkins because it might be a health risk. The dining room tables are laid for lunch by the night staff. The home’s cook said she often makes cakes, but people living in the home are not asked if they would like to participate. Care plans contain limited information about hobbies people had before moving into the home and there is no guidance for staff on how they can support people to remain active. People who use the service said the food provided was very good and that they always had enough to eat, although they did not think they had a choice of main meal each day. The records showed only one main meal was offered each day, although the cook said people could ask for something else if they The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 17 wanted it. She said because the home is so small she knew when someone did not like the main meal and always gave them something different. A record of these choices was kept. People living in the home could not remember if they were asked each day about the main meal and seemed surprised when told the day’s meal was curry. The daily menu is not displayed anywhere for people to see. The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can be confident there are systems in place that enable them to raise concerns and have them addressed. Staff need training and guidance on how to manage safeguarding issues if the risk of abuse is to be minimised. EVIDENCE: A copy of the complaints procedure was displayed in the entrance hall and was also included in the statement of purpose. This informed people who use the service that any complaint they made would be recorded in the complaints log, investigated and the complainant informed of the outcome. The AQAA recorded that no complaints had been made and the commission had not received any either. Staff said there had been a very recent complaint made by a relative, but the complaints log could not be found to see if this had been recorded or dealt with. The area manager was not aware of any complaint having been made. People who use the service said they could speak to staff about anything that concerned them. No one spoken with said they had made any formal complaints since they moved to the home. Three relatives also said they knew how to make complaints but had not had to make any. The AQAA did not record whether the safeguarding policy and procedure had been recently reviewed and the area manager had stated that a review of all The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 19 policies and procedures needed to be carried out by the providers who, on registration, had adopted the existing ones completed by the previous owners. Staff spoken with had not attended any training courses about safeguarding, although those who had completed their National Vocational Qualification (NVQ) said there had been a section on safeguarding included in the course. One member of staff who had completed her NVQ knew what action she should take if someone made an allegation of abuse to her. The AQAA showed that the providers had identified the need for safeguarding training and planned to arrange it during the next 12 months. The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean and safe, but people who use the service would benefit if a renovation programme was introduced that redecorated the areas that are worn and shabby. Staff need training or refresher training in infection control if the risk of infection is to be minimised. EVIDENCE: People who use the service said they liked their environment and thought it was comfortable. The home is showing signs of wear and tear and looks shabby in places. Two bedrooms smelt extremely unpleasant. The care staff and cleaner explained that this was because the carpets needed cleaning every day and did not have time to dry out. The area manager said an alternative floor covering would be fitted as a matter of urgency. On the upstairs landing a lampshade was missing. Many bedrooms had curtains that were coming off The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 21 the rails as the hooks were broken or missing. Bedrooms do not have lockable storage space where people who use services may store their belongings. The kitchen has cupboards that do not shut properly. The downstairs bathroom has a hoist where the coating has peeled off the base and in an upstairs toilet the handrails have been wrapped in tape to cover where this has occurred. The area manager said the providers were looking at a long-term renovation plan and the AQAA confirmed this. Some bedrooms have been redecorated since the new providers took over. A cleaner works in the home five mornings a week and cleans the communal areas and bedrooms every day. The cleaner said there is no cleaning schedule but they follow their own routine to make sure everywhere is kept to a good standard. As stated previously, staff are also expected to carry out many of the cleaning tasks such as the laundry and kitchen areas. The home has a small garden that people living in the home said they liked to spend time in during the warm weather. This is quite overgrown as the hedges have not been cut back and are encroaching onto the lawn area. There is some space where tables and chairs could be put, but no flowerbeds or shrubs. Staff said they thought there was a bird feeder but no one seemed to be responsible for seeing it had food in it. The home does not have an office and all records relating to the day to day running of the home are kept in a filing cabinet stored in the dining room or on a shelf in the kitchen. Any meetings have to be held in the communal areas of the home, which has an impact on the people who use the service, as they then cannot use these areas. There is a small laundry that can easily manage the washing and people who use the service said they got their laundry back quickly. The washing machine has a suitable programme for the disinfecting of soiled linen. It was not possible to establish whether the home had a contract for the disposal of clinical waste as this section of the AQAA was not completed and no contract could be found during the visit. However, staff knew how to dispose of clinical waste. Communal bathrooms had bars of soap and cotton hand towels in them, which could be a source of cross contamination. The area manager removed the soap at the time of the visit and went and purchased liquid soap to replace it. He also agreed to purchase paper hand towels. The AQAA had not recorded how many staff had received infection control training, but some staff said they had completed it a long time ago. The Wight House Care Home DS0000070368.V361324.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is an employment procedure but this must be used consistently if risks to people who use services are to be minimised. A review of training needs to be completed and a programme of induction, training and supervision introduced if staff are to maintain and develop the skills they need to provide care. EVIDENCE: The five people living in the home who were spoken with said staff were quick to offer assistance when needed and that they thought there was usually enough staff on duty although ‘they are always very busy.’ The rota showed there were normally two staff on duty during the mornings, afternoons and evenings, although staff said this included the acting manager’s hours. Also during the afternoon/evening shift one member of staff has to prepare the tea, which means there is only one person available to assist people using the service. One waking and one sleeping night staff covered nights. Due to the lack of space the night staff slept on a camp bed in the small upstairs lounge. During the morning the cleaner is also working in the home on Mondays to Fridays and a cook provides the main meal 7 days a week. At the time of the visit, two care staff and the cleaner were working in the home and the cook arrived The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 23 in time to prepare lunch. Staff said they felt able to complete their duties with the current staffing levels, although as previously stated, they did not have time to spend with the people who lived in the home engaging in social activities. The AQAA recorded that five of the fifteen care staff have completed a National Vocational Qualification (NVQ) and that three more wish to do it. A certificate for one staff was seen on her file. One staff spoken with said the acting manager said a course was starting shortly and that she had been put forward for it. The AQAA stated that all staff have a Criminal Records Bureau check (CRB) completed prior to their employment. Files for staff who had worked at the home for over a year had evidence to support this statement. The question in the data section asking whether recruitment checks had been completed for all staff had not been answered. However, the files for two staff, recently employed showed their Protection of Vulnerable Adults (POVA) First check and CRB check had been returned after they started working in the home. One of the staff said this was correct, but that she had been supervised at all times and had not been allowed to work alone with anyone until her check was returned. There was no evidence to support this statement in her file. The same person’s file had only one reference and this was not one that had been requested by the providers but one she had brought with her. A survey completed by one member of staff stated that her CRB was sent for after she had started work in the home. This information was shared with the area manager, who said the organisation’s policy was very clear and that no one should start work until the CRB had been returned. He said he had recently refused to let someone who had worked previously in the home return to work there without a new check being completed first. Information from four staff survey forms indicated they felt they had received a good induction that enabled them to provide care. The files for two new staff contained two induction workbooks. One of these had been partially completed with dates and signatures for the completion of various aspects of care practice. The other, belonging to the newest member of staff referred to above, had not been used. The member of staff said she had not been working from it, but had spent time shadowing experienced staff until she felt confident to work alone and her employment checks had been completed. Staff training records showed regular training had been taking place, prior to the new providers taking over. Courses attended by some staff in the last two years included NVQ and ‘Understanding Dementia and Challenging Behaviour.’ The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 24 Staff had had the opportunity to attend a training course in food hygiene in January 2008. The AQAA identified the need for a review of training to be carried out and a training programme put in place to make sure all staff received the training and refresher courses they needed. There were records for staff supervision, but no entries since the registered manager left at the end of last year. Staff said some of them had had supervision but did not know when their next session would be. Feedback from the five staff surveys confirmed two thought they had regular supervision but three did not. The acting manager has not had any training in how to give supervision. The Wight House Care Home DS0000070368.V361324.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not well managed or run for the benefit of the people who use the service. The regular servicing of equipment promotes the health and safety of the people who use the service, but staff training needs to be reviewed to ensure they have the knowledge they need to keep people safe. EVIDENCE: The home has been without a registered manager since September 2007. The providers did not inform us the registered manager had left until we wrote to them asking for clarification of the management arrangements. The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 26 We wrote on 18th January 2008 to the responsible individual asking for clarification of the management arrangements. We received a response dated 21st February 2008, stating arrangements were being made to fill the position. To date we have not received confirmation of any appointment. Therefore, the provider must ensure that a suitable and competent person is appointed to manage the home and arrange for an application to register a manager to be submitted. The acting manager is an experienced carer but is not qualified, has only basic management skills and minimal experience in running a home. The AQAA stated an objective was to enable the manager received appropriate support to continue in and develop her role. She also needed to complete NVQ 4 training. The area manager was appointed in January 2008 and said the day of the visit was only the third time he had been to the home. There was no evidence the providers had been visiting the home on a monthly basis to carry out an audit of the service and no reports made under Regulation 26 could be found. The providers stated the area manager was contactable by phone at all times, so the acting manager could ask for support and advice. The previous providers had a system for getting the views of the people who use the service and a review of the feedback was included with the new provider’s application. There was no evidence that people who use the service had been asked for feedback since the home was taken over by the current providers. The AQAA was completed within the required timescale but was very brief and gave little information about the service. The questions relating to the views of people who use the service and to equality and diversity were particularly poorly completed. Areas of the data section were left blank. The AQAA did not give us a reliable picture of the service. People who use the service said the home held money for them, which they could ask for when they needed it. Brief records of income, expenditure and the balance were held and the record signed to evidence transactions. One person said he was happy to let the manager look after his money, as he did not have anywhere safe to keep it in his room. The money held for the people who use the service is not stored in a very secure place. Staff training has already been referred to in Section 6 of this report. Some staff said they had previously had training in infection control and recent training had included food hygiene but there was no system for monitoring when refresher training was needed. None of the three files seen contained evidence of recent first aid training, moving and handling or infection control. The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 27 An independent trainer had given fire safety training in December 2007 but it could not easily be established whether in house training had been given to anyone who was not able to attend. The area manager did not know whether the contract for the trainer had been renewed, but he was aware fire training needed to be arranged for 2008. The AQAA included a list of dates when equipment had been serviced. This showed that systems were being maintained. Certificates were seen that evidenced these checks had been carried out as recorded. Fire safety checks were being completed by the home, although there were some gaps. The accident book had been used to record any injury to people who use the service. We had not been informed of one recent incident requiring an emergency visit to hospital as the home is required to do. A number of areas are not been managed effectively or consistently and have been referred to in the relevant sections of this report. These are • • • • • • • • • • Pre admission assessments Care plans and risk assessments, reviews of care plans, involvement of people who use the service in care planning and review Medication practice, storage and staff training Lack of activities in the home and the task centred practice of staff Safeguarding – the lack of staff training The lack of a renovation programme for the home and the failure to repair minor faults such as missing lampshades and broken curtain hooks. The lack of a staff training programme Failure to follow the recruitment procedure consistently Failure to notify the commission the home was without a registered manager Failure by the providers to effectively monitor the home The providers must address these areas of concern. The Wight House Care Home DS0000070368.V361324.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 X 2 1 X 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 1 13 1 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 2 1 X 1 The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? N/A 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 OP3 Regulation 14 Requirement Timescale for action 31/07/08 2. OP9 13(2) 3. OP9 13(2) The current assessment of need must be developed further so it provides sufficient information about each of the sections detailed in standard 3 so that the manager can identify what support the person will need and whether the home can provide this level of support. 01/05/08 The current practice of putting unused medication back into the monitored dosage system and taping it in place must stop. A system must be put in place for recording and returning unused medication to the pharmacist that meets the Royal Pharmaceutical guidelines for the safe handling of medicines to ensure medication is disposed of safely. The wooden cupboard currently 31/07/08 being used to store medication must be replaced with one that meets the requirements of the Royal Pharmaceutical guidelines for the safe handling of medicines so that it can be stored safely. DS0000070368.V361324.R01.S.doc Version 5.2 The Wight House Care Home Page 30 4. OP18 13(6) 5. OP29 19(1) 6. OP31 8(1) 7. OP38 13(4)© and (5) 8. 9. OP38 OP33 37(1) © 26 All staff must have training in respect of safeguarding to ensure they have the skills and knowledge they need to minimise the risk to service users of abuse. The registered person must ensure the recruitment procedure is consistently applied and the guidelines for CRB and POVA checks followed at all times prior to staff working in the home. This is to ensure service users are protected. The registered person must appoint a manager who must submit an application for registration with the commission. The registered person must ensure all staff have up to date mandatory training in moving and handling, first aid and infection control. The registered person must notify the commission of any serious injury to service users. The registered person must ensure a monthly visit is made to the home and a report of each visit is available at the home for inspection at all times to demonstrate they are monitoring the service. 31/07/08 01/05/08 31/07/08 31/07/08 01/05/08 01/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations That more detailed care plans be developed that record the actual care given by staff and that the people who use the service are involved in writing them wherever possible. DS0000070368.V361324.R01.S.doc Version 5.2 Page 31 The Wight House Care Home 2. OP10 3. OP12 4. 5. OP15 OP19 The current practice of using communal books to record individual baths and bodily functions should be reviewed as this does not record confidential information in an appropriate way and does not uphold the service user’s rights to privacy and dignity. That the current practice of staff having to complete a list of daily tasks be reviewed to see if more time can be allocated to providing mental stimulation to the people who use the service. That the menus are reviewed to offer two choices of main meal each day. That a programme of renovation is developed. This should include looking at the possibility of providing office space so the registered manager has somewhere to carry out the day to day management tasks and store confidential records. The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Wight House Care Home DS0000070368.V361324.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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