Inspection on 12/09/06 for The Wingfield Care Home

This inspection was carried out on 12th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 Wingfield Care Home 29/09/05

The Wingfield Care Home 04/04/05

The Wingfield Care Home 03/09/04

The Wingfield Care Home 05/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Wingfield Care Home(The) 70 Wingfield Road Trowbridge Wiltshire BA14 9EN Lead Inspector Susie Stratton Unannounced Inspection 12th September 2006 10:20 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 Wingfield Care Home(The) DS0000032366.V313797.R02.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. Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wingfield Care Home(The) Address 70 Wingfield Road Trowbridge Wiltshire BA14 9EN 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) 01225 771550 01225 771559 wingfield@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Limited Mrs Linda Stella Hallett Care Home 89 Category(ies) of Dementia - over 65 years of age (57), Old age, registration, with number not falling within any other category (89), of places Terminally ill (2), Terminally ill over 65 years of age (2) Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. The manager for the registration must be registered on Level 1 (adult and mental health) NMC register. The 32 bedded unit may accommodate a maximum of 2 service users with a terminal illness, either over 65 years (TI(E)) or under 65 years of age(TI) The 32 bedded unit may accommodate persons with old age not falling within any other category (OP) over the age of 50 years. The 32 bedded unit may use only rooms S1, S3 or S8 for double occupancy. The 57 bedded unit may accommodate up to 5 service users in the age range 50-64 years. The registered manager must always be supported by a designated deputy for the 57 bedded nursing unit who is registered on Level 1 (mental health) NMC register or has demonstrated equivalent in qualifications/experience and by a designated deputy for the 32 bedded unit who is registered on Level 1 (adult) NMC register. The staffing levels set out in the Notice of Decision dated 7 July 2006 must be met at all times. 29/09/05 7. Date of last inspection Brief Description of the Service: The Wingfield is a care home providing nursing care for 89 elderly persons. There were 89 persons resident at the time of the site visits and the home has a long waiting list. Accommodation is provided in two buildings in a campuslike arrangement. The building at the front of the site is called the Lodge, it has 32 beds and is registered to care for older persons with general nursing and care needs. While it may admit service users over the age of 50 years, any persons who are under 65 have similar nursing and care needs as those over the age of 65. Some of the residents in the Lodge are very frail and have highly complex nursing needs. The main building at the back of the site has 57 beds and specialises in providing nursing and care to persons with dementia care needs. It may also admit persons over 50 and when such persons are admitted, they have dementia-related conditions. Some of the residents in the main building have highly complex needs relating to mental health nursing and care. A GP surgery is situated on the same campus, it is an entirely separate facility. The Wingfield is owned by Barchester Healthcare Limited, a national care provider. The main building was opened in January 2003 and was purpose built in Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 5 accordance with the National Minimum Standards for Older People. The accommodation is over two floors, served by a lift and stairs. A security lock system is used on the doors to the stair wells and to the outer reception area, to reduce the risk to service users with dementia care needs. All rooms are single and have en-suite facilities. There are a variety of different communal areas and a central, enclosed courtyard garden. The Lodge has undergone a major refurbishment, which was completed in May 2005. The refurbished accommodation was completed to a high specification. Accommodation is provided over three floors, with a passenger lift in-between. All rooms are ensuite, three specified rooms may be used as double rooms if an established couple wish to share. There are communal rooms on each floor and a wheelchair accessible front garden. The Wingfield is situated on the outskirts of Trowbridge, a large town with good amenities. Car parking is available on site and a bus stop is close to the entrance. A railway station is about 5 minutes away by car. The home is managed by Mrs Linda Hallett, who is an experienced manager and registered mental health nurse. She is supported by two deputy managers, a training manager, registered nurses, care staff, activities coordinator, catering staff, administrators, maintenance man and ancillary staff. The fee range is £790 £850 per week. Service users guides are available in the two entrance halls. One relative commented on their general availability. Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. As part of the inspection, 30 questionnaires were sent out and 9 were returned. Comments made by residents and their relatives in questionnaires, during the inspection and from relatives, GPs and social workers, who were contacted after the first two site visits, have been included when drawing up the report. The home also provided information requested by the CSCI prior to the inspection, relating to residents and staff. As the Wingfield is a large registration, the site visits took place over three days, on Tuesday 12th September 2006 between 10:20am and 4:10pm, Wednesday 13th September 2006, between 9:20am and 2:30pm and Monday 16th October 2006 between 9:25am and 11:55am. The first site visit was unannounced. The deputy manager was on duty for the first two site visits and the registered manager for the third visit. During the site visits, the inspector met with 23 residents and 4 visitors, and observed care for 28 residents who were unable to communicate. The inspector reviewed care provision and documentation in detail for 9 residents, two of whom had recently been admitted. The relatives, GPs and social workers (if applicable) of these residents were written to, to gain their opinion of the quality of care provided. As well as meeting with residents and visitors, the inspector met with both deputy managers, four registered nurses, six carers, the training coordinator, the catering manager, two domestics, the laundress, the maintenance man, three administrators and two activities coordinators. The inspector toured all the building and observed three lunchtime meals and three activities sessions. Systems for administration of medicines and all three clinical rooms were inspected. A range of records were reviewed, including staff training records, staff supervision and employment records, maintenance records and financial records. What the service does well: All residents have clear and detailed assessments and care plans, which residents or their supporters are involved in drawing up and key workers involved in review processes. Care plans related to care provided to residents and all residents have ready access to their care plans. In the parts of the home specialising in dementia care, the home ensured that practice ensured the privacy and dignity of residents. The home offers a full activities programme to residents, activities are suited to the different needs of the range of residents in the home. The home is well-maintained and suits the Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 7 needs of the residents cared for. Good practice was observed in relation to hygiene and ensuring systems are in place to prevent spread of infection. The home is well staffed and training is supported for all staff. The manager of the home is an experienced registered nurse and is keen to innovate to improve care provision. Barchester maintains an effective system for quality audit. Residents, visitors and staff are protected by the home’s systems for ensuring health and safety. Residents and their relatives commented about the quality of care offered by the home; one reported “Yes, they are really good at listening to what we have to say”, another said “The home has a number of strengths” and another reported “Couldn’t find anywhere better anywhere else”. Some persons commented on the environment offered by the home, one said how much they liked the flowers in the central courtyard, one person described the home as “Lovely” another as “beautiful” and another commented “The facilities at the nursing home are superb”. Some people commented on the quality of the staff, one reported “There are some very good young care staff at this home”, another said “They are to be commended for their attention and kindness” another reported “The courtesy of the staff and their commitment to make [my relative] as comfortable as possible is impressive” and another commented “I come away reassured that [my relative] is in good hands”. What has improved since the last inspection? Ten requirements and nine good practice recommendations were identified at the previous inspection. A copy of the most recent inspection report is now included in the service users’ guide, so that all persons are fully informed about the service provided. If a resident is assessed as having a risk of pressure damage, a care plan is now always in place to detail how risk is to be reduced. All frail residents who are not able to assist themselves now have a full written record of fluids and food provided to them, so that staff can be sure that they are receiving the diet and fluids that they need. They also have written evidence that frail persons who cannot move themselves have their position changed regularly to prevent pressure damage. Staff now complete records relating to personal care and service users’ bowel movements on a daily/regular basis, to ensure that personal care needs are met. Precise language, which describes presenting needs or symptoms is now used in nursing and care records. Where relatives have expressed wishes on behalf of a service user in the event of sudden collapse, this is now signed by the relative, as well as the residents GP. Records relating to wounds included response to treatment, including wound size, dimensions, presence of exudate and other relevant matters. The records of day-to-day care, which are kept in resident’ rooms, were all fully updated, to reflect the care provided. The care plan of one resident who was identified during the inspection had been updated, to reflect the changes needed to their risk assessment. Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 8 Items requiring secure storage are not stored in the Controlled Drugs Cupboard, as this is contrary to the Medicines Act, and alternative secure storage has been identified. Residents’ individual medicines administration records are now always completed at the time of administration. If the medicine is not administered for any reason, this is now documented on the same record. A British National Formulary is available to inform registered nurses administering drugs of the actions of drugs they are administering. All hand written medicines instructions had been countersigned by a second person. Where a resident was prescribed a drug for use in an emergency, the prescription was continued on their current medicines’ administration record. Where a resident was prescribed a drug for the management of pain, this was now included in their care plan, so that staff can regularly evaluate the effectiveness of the pain-relieving drug for the person. All staff references were directly sourced and “To whom it may concern” references were not accepted. All used commodes had been cleaned. Staff no longer moved wheelchair users without footrests. The fire drill record was dated. What they could do better: 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. Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 5: The home does not provide intermediate care, so 6 is N/A Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visits to the service. All prospective residents have full and detailed assessments of their nursing and care needs prior to admission. Prospective residents and their supporters are encouraged to visit the home before admission. EVIDENCE: The manager or one of her deputies performs detailed pre-admission assessments on all residents before admission. Where relevant, assessments from other professionals, such as the diabetic nurse, are obtained prior to admission. Nurses in charge of floors reported that they were informed of prospective admissions, both verbally and in writing, prior to admission, so that they could properly prepare for the resident’s arrival. As many of the prospective residents have some degree of communication difficulty, a more detailed assessment is completed for all residents soon after admission, to ensure effective care plan development. Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 11 Very few of the residents had been well enough to be able to be involved in visiting the home before admission, however several relatives reported that they had been able to visit the home before deciding about admission. One reported that they were “impressed at the first visit and have remained so”; another reported that they had made several visits and each time had been made “very welcome”. Wingfield Care Home(The) DS0000032366.V313797.R02.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 Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visits to the service. Residents are protected by full plans of care relating to their nursing and care needs. Some frail residents could be put at risk of tissue damage as there is not full evidence that all residents have their positions changed on the frequency indicated by their care plans. There are safe systems for the administration and storage of medicines. In a highly complex client group residents’ needs for privacy and dignity are up-held. EVIDENCE: All residents have full care plans in place, which have been developed from an assessment of their nursing and care needs. Care plans are reviewed regularly or when a residents’ condition changes. All residents are assessed for risk such as manual handling, tissue damage, nutritional risk and falls. If risks are identified, care plans are put in place to direct staff on how risk is to be reduced. Many of the residents are not able to participate in developing their care plans, where this is the case, relatives report that they have been involved. The manager is keen to involve residents and their representatives in care planning as much as possible and to this end is undertaking a pilot Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 13 project of keeping all of a resident’s care plans and daily records in their rooms. To ensure confidentiality, such records are securely stored in each resident’s room. Carers spoken to reported that they found review and completion of records easier, as they could do this while or immediately after caring for residents, rather than having to go and access records in a secured office. Key workers spoken with clearly knew their residents needs in detail, they also reported that they were involved in the review process with relatives and social workers. Most of the residents in the larger building have nursing care needs relating to complex mental health care. They all had care plans in place, detailing what their mental health care needs were and the actions staff were to make to meet them. Their care plans were written in a non-judgemental style. Occasionally staff reported on information which was not documented in their notes, for example one resident was being given alcohol, which they enjoyed, in a certain way such as to reduce risk to themselves. Staff knew about why this was but it was not documented in their care plan. Liquid paper had been used in a few records to make changes. Where errors have been made in residents’ records, as they are legal documents, it is advisable that a line is drawn through the entry, rather than using liquid paper. Some of the residents in the home were very frail and cared for mainly in bed. Where this was the case, they had monitoring charts in place, to ensure that their position was changed regularly, that they were offered regular fluids and diet and to prevent tissue damage. All records relating to fluids were completed in full and provided evidence that residents were being given fluids in accordance with their assessed needs. Food charts also showed that the resident was given meals in accordance with their assessed needs, however for some meals entries such as “liquidised diet” were documented, rather than what the liquidised meal actually was. It is advisable that the actual diet is recorded to assist in ensuring that the resident has been given a well-balanced diet. Where supplements were prescribed, it was documented when they were given. Where a resident required regular changes of position, it was noted as good practice that documentation stated precisely how often the resident needed to have their position changed. However in some cases, records did not show that the resident had had their position moved at the frequency that they were documented as needing. In order to minimise risk of tissue damage, where residents are assessed as needing to have their position moved at a certain frequency, their records must always reflect that this has taken place. Records and discussions with staff provided evidence of close working relationships with residents’ GPs and other external health care professionals, such as the physiotherapist and dentist. The three GPs who contacted the CSCI after the inspection all gave favourable responses on the quality of care offered by the home. All residents who had wounds had clear records so that staff could assess their response to treatment. Despite there being high degrees of continence care needs amongst residents in the home, very few urinary Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 14 catheters were being used and where they were, full records were in place, including the clinical indicator for the use of the catheter. Diabetic residents all had care plans and monitoring systems in place. As different diabetic residents may have different needs in relation to the management of their diabetes, it is advisable that the actual blood sugar level be documented and the use of words like “normal” avoided. The home has one area on each floor and one in the lodge for safe storage of medicines. There is a full audit trail for medicines brought into the home and disposed of. Where medicines administration records needed to be changed by hand, these were counter-checked by a second registered nurse. Three medicines rounds were observed during the inspection and they were observed to be carried out safely, in accordance with current guidelines. There were safe systems for the storage of medicines requiring cold storage. All limited life medicines were dated on opening. Where residents required the regular administration of medicines by injection, there were systems in place to ensure that injection sites were rotated, to prevent tissue damage. Controlled Drugs were correctly stored and full records maintained. Where residents were prescribed drugs which can affect activities of daily living such as mood altering drugs, aperients or painkillers, this was documented in their care plan, to ensure that relevant persons could be informed of the resident’s response to drugs treatments. Many of the residents in the larger building experienced problems relating to behaviour. During the inspection, it was observed that where residents were not aware of such needs, staff acted promptly to ensure the privacy and dignity of residents. For example, one resident tended to remove clothing and staff were observed to quietly support them in ensuring that their dignity was maintained. It was observed that where residents showed behaviours which needed attention, staff approached them quietly, so as not to distress them, without raised voices, using the person’s own preferred name. Where residents wandered into another resident’s room, they were gently assisted to leave. All personal care was performed behind closed doors. It was observed that when one carer was going off duty, they took time to come and explain to the resident that they were going off duty and when they would be back on duty the next day. There were clear systems in the laundry to ensure that residents’ clothing was returned to them. It is also much to the home’s credit, that despite many of the residents suffering from incontinence, including double incontinence, no areas of the home exhibited odour during the three site visits. Wingfield Care Home(The) DS0000032366.V313797.R02.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 Quality on this outcome area is excellent. This judgement has been made from evidence gathered both during and before the visits to the service. Residents are provided with a full activities programme, which suits their needs. Residents are supported in maintaining links with persons important to them. In this complex client group, staff work hard to encourage residents in exercising choice. The home is actively working towards providing a wide range of nutritious meals in pleasant surroundings. EVIDENCE: The Wingfield offers a comprehensive activities programme, with four activities coordinators, who are able to offer a service seven days a week. Activities are offered in both buildings and the range offered varies widely, depending on the needs of the different client groups. An activities programme is drawn up and made available to residents. Activities coordinators reported that the programme was developed with residents, their supporters and staff and also from experience of what the client group enjoyed. Residents expressed their appreciation of the service. One person reported that “The activities programme & its leader is a real strength of the home” another said “The activities girls are excellent” and another simply described activities as “fun”. Several residents also commented on their appreciation of the religious services. Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 16 All residents have a full and detailed social care assessment and care plan. Activities coordinators also perform a key worker role, as care staff do, for individual residents and are involved in care reviews. Social care assessments and care plans are completed in depth and provide a clear picture of the resident’s past life and their interests. This is of much importance as so many of the residents are not able to communicate. Staff spoken with were aware of these records, as they were readily available; they reported that they used them when caring for individuals, bringing up matters which they hoped would be of interest to the resident and would thus help support them. The home are to be much congratulated for all the work that they have put into this area. The home owns a mini bus and is able to take residents out if they wish. One resident commented on how much they liked these trips, particularly visits to garden centres. Visitors are able to come and go as they wish and many of the residents commented on how supportive they found this to be. One relative commented on how they appreciated an older relative of theirs being able to join in with activities with their spouse, when they visited. During the inspection, it was noted that the home worked to ensure that established couples could spend as much time together as they wished to. One such person commented on how much they appreciated this. Residents commented that they could spend their lives as they wished. One said “I do what I like anyway”, and another said “If I don’t want to go to something, they won’t make me” . Residents said it was up to them when they got up and went to bed. In the larger building, residents were able to wander as they wished and were not restricted to their rooms if they did not wish to be so. One service user was observed to spend most of the day walking in the enclosed garden. The home encourages residents to personalise their rooms if they wish and some of the rooms in all parts of the home were very personalised, reflecting the residents’ likes and preferences. As would be anticipated in a large establishment, there was a range of opinions about the meals provided, comments ranged from “excellent” through “satisfactory” to “reasonable”. Several residents commented on the choice of meals and quite a few commented on how much they liked the puddings. The chef is very motivated and works hard with her staff to ensure that residents’ needs can be met. Where residents have individual preferences, she is pleased to meet with them and their relatives to try to provide meals which the resident likes. She showed a detailed knowledge of the dietary needs of persons with dementia care needs and frailer persons. Three mealtimes were observed across all floors of the home and in the lodge. Meals, including liquidised meals, were attractively presented and were hot. The chef reported that the provider only uses fresh meat and all soups and cakes are cooked from raw ingredients, with pre-prepared meals used only in emergencies. Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 17 Residents were encouraged to eat in one of the three dining rooms. The dining rooms were light and the furnishings comfortable. In the Lodge, the proprietors have aimed at a dining room which has the appearance of a hotel. Staff were available to support residents throughout the mealtimes. Mealtimes were effectively managed, to ensure that residents who were not eating in the dining rooms received their meals promptly. Where residents needed support to eat, care staff sat with them encouraging them and feeding them when necessary. All residents had a choice of drinks at mealtimes. Wingfield Care Home(The) DS0000032366.V313797.R02.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visits to the service. The home has a complaints procedure which works in practice. Residents in this complex care group are protected from abuse. EVIDENCE: The complaints procedure is displayed in the main entrance halls and was available in the service users’ guide. Residents who were able to communicate were able to say how they would bring up concerns. Most were confident that if they spoke to one of the senior nurses or the manager, that issues would be addressed. Relatives also reported that they were able to raise issues on behalf of their relative. One resident said “I tell anyone, staff are sympathetic here”, another said “They are always available to listen”. Several residents said that they had nothing to complain about, one said “I don’t have any axes to grind here”. The home has a clear documentary system for complaints. Complaints forms are available at all nurses stations and staff spoken with knew their responsibilities for completion. Verbal concerns were documented as well as complaints. One complaint has been made to the CSCI since the last inspection, it was correctly investigated by the home’s manager. The issue was not up-held. Complaints are monitored centrally by Barchester as part of their quality audit. A review of the complaints register showed that all are responded to in accordance with Barchester’s timescales. The area managers also review all complaints and concerns every time they visit the home. Staff grievances are Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 19 dealt with in the same manner and a review of a recent issue showed that the home’s managers worked to resolve issues by facilitating staff in talking to each other. Two vulnerable adults investigations have taken place since the previous inspection. Both were reported by the home in support of a vulnerable adult. The multi-agency investigations showed that the home had taken appropriate action to support the vulnerable adults before and after the investigation. All staff, including ancillary and other support staff, have been trained in abuse awareness and staff spoken with knew their responsibilities under the procedure. Where residents needed restraints such as safety rails, there was full documentation and these were regularly reviewed. Many of the residents in the larger building, due to their mental health care needs, exhibit complex behaviours. All such behaviours are documented, including “near misses”, so that managers can ensure resident safety. Where complex or threatening behaviours were observed between service users during the inspection, staff dealt with them effectively, not overreacting or using judgemental terms when supporting residents. For example, two residents were observed to raise their voices to each other and one raised their fist. The staff member watched what was going on quietly, then led one of the residents away and helped them to sit elsewhere. A few minutes later this resident went and sat back next to the first resident and talked to them about the weather. Wingfield Care Home(The) DS0000032366.V313797.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24 & 26 Quality on this outcome area is excellent. This judgement has been made from evidence gathered both during and before the visits to the service. Residents live in a well-maintained environment. There are a wide range of communal areas for residents to chose from, including a range of sanitary facilities. Residents live in large, comfortable rooms and equipment is provided to meet their needs. Full systems are in place to ensure prevention of spread of infection and in this complex speciality all areas of the home inspected were clean and smelt fresh. EVIDENCE: The Wingfield is well maintained in both buildings. The Lodge was recently refurbished to a high specification. The larger building is also a comparatively recent build. All rooms are single and all have ensuite, although certain rooms in the Lodge can be used as double rooms, if an established couple wish to share. All rooms exceed National Minimum Standards for room sizes. This means that each room can be laid out according to resident preference and Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 21 nursing need. The maintenance person is enthusiastic in his role and was fully aware of his responsibilities. He maintains clear maintenance records. There are a wide range of communal rooms across both buildings. Some communal rooms are large and are supportive of large group activities, others are smaller, so that smaller groups can take place or a resident can just sit quietly with a visitor. The Lodge has a garden area at the front of the building and the main building has an attractive courtyard garden, with a range of features for residents to enjoy, in the centre of the building. The area is fully enclosed, so that residents can walk here as they wish, without risk to themselves. A variety of different baths and showers are provided, to support residents with different disability needs. Disabled WCs are located close to all communal rooms. Many residents expressed their appreciation of the facilities offered. One person described their room as “very large”, another as “airy” and another as “comfortable”. One resident commented, “I do like being able to look out of the window” and another said, “It’s a lovely building”. Residents are supported in bringing in their own items if they wish and some of the rooms were highly personalised, reflecting the person’s likes and preferences. A wide range of equipment to support residents with disability was available. There were a range of hoists to support residents who have manual handling care needs. A full range of pressure-relieving equipment was provided and all cushions on all armchairs across the home are pressure relieving. A range of opinions were expressed about response times when call bells were used, one person said “If I ring my bell, they come very quickly”, another said “Staff come as soon as they can” and another said “Staff do not always answer the bell promptly”. The main building has a system in place to monitor response times when call bells are used, which is reviewed regularly. The print-out showed that response times were generally under one minute. A full upgrading system for the Lodge call bell system had been put in place and was awaiting final completion of commissioning. This included a pendant system for more mobile service users and an electronic monitoring system. Safe systems were in place to prevent the spread of infection. Staff were observed to care for residents in accordance with universal precautions. Two domestics were observed performing their role, they were careful in what they did, working in an organised, thorough manner. One domestic reported that she had ready supplies of equipment and chemicals to perform her role. Sluice rooms are available for disposal of waste. The damaged walls in two of the sluice rooms had been repaired by the third day of the inspection. It was noted as very good practice, that all staff uniforms were now laundered by the home, at appropriate temperatures. This will do much to prevent risk of spread of infection. A standard system for separation of used and potentially infected laundry is in place. Most laundry is performed in the main laundry in the main building although there is a small support laundry in the Lodge. The laundry Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 22 was a busy area and on the first day of the inspection, it was noted that laundry items were being sorted on the floor. This was investigated by the deputy manager and staff were advised that this could potentially cause risk of cross infection, as any microorganisms in bedding and clothing can be brought back into the building on staff shoes. The practice had ceased by the third day of the inspection. The laundress reported that she had a ready supply of gloves and aprons and she clearly understood the importance of their use. Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 23 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 Quality on this outcome area is excellent. This judgement has been made from evidence gathered both during and before the visits to the service. Residents are supported by the numbers of staff on duty and the skill mix of staff employed. Training is encouraged, this includes NVQ training and training in dementia care, so that staff can meet the needs of residents in the home. Residents are supported by a safe recruitment system for new staff. EVIDENCE: The Wingfield is required to staff the home in accordance with a condition of registration; the home consistently exceeded this condition. A range of registered nurses, with different skills to meet different resident needs, are in post, and there is always one registered nurse on duty on each floor of the main building and in the lodge. As well as nursing staff and carers, the home employs a full range of domestic, laundry, catering, maintenance, administrative and activities staff. Many of the staff have worked in the home for several years. Where a member of staff’s first language is not English, there are managerial support systems in place to improve and develop their English language skills. The manager is supportive of equal opportunities and when more senior posts become vacant or further training opportunities are offered, staff are put forward on the basis of their skills, not background. Several staff from ethnic minorities now hold senior positions in the home. Over 50 of care staff are trained to NVQ level 2 or above. The home employs a training coordinator. Clear records of training offered are in place, Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 24 so that managers can see at a glance who has done what training. All staff are given regular training in dementia care, to support practice in this specialist area of care. This is reflected in staff attitudes towards those residents in the main building who have complex mental health care needs. A standard system for induction of new staff is in place and a review of four records showed that matters were covered individually, in accordance with the guidelines in the programme. The home also supports all its staff in training, for example two of the registered nurses are undertaking an associate mentor course. The training manager also regularly reviews skills amongst registered nurses to ensure that the home has the correct skills base to meet residents’ nursing needs. Barchester operates a clear recruitment policy and procedure. The home are working within these procedures. All staff submit an application form or c.v., police checks are performed prior to employment and all staff complete a heath questionnaire. Two references are obtained for all persons prior to employment and it was noted as good practice that where one individual had a reference which raised issues, a further reference had been obtained from a third referee. One of the references for one of the ancillary workers was not dated and it is advisable that references should all be dated. The source of this reference was clear. Staff files include copies of certificates obtained. All nursing and care staff are interviewed using an interview assessment questionnaire. It was clear from records that ancillary staff are also interviewed, however one ancillary staff did not have an assessment questionnaire completed and it is advisable that one is completed for all staff before employment. All staff have terms and conditions of employment and job descriptions, which they have signed, on file. Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality on this outcome area is excellent. This judgement has been made from evidence gathered both during and before the visits to the service. Residents are protected by an experienced manager, who is also a registered nurse. She is fully aware of her responsibilities. Barchester Healthcare operates a robust system for audit of quality of care and effective action is taken if issues are identified. Staff supervision takes place, to ensure that they are supported in their roles when providing resident care. Residents’ financial interests are safeguarded. There are clear and effective systems to ensure that residents, staff and visitors are protected by the home’s systems for ensuring health and safety. EVIDENCE: The Wingfield is managed by an experienced registered nurse and manager. The manager holds the Managers Award. She has been in post since the home opened. Reviews of systems in the home and discussions with staff indicated Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 26 that she is keen to innovate to support resident care. She also puts forward areas for improvement to the provider. Records showed that the manager is able to work with her staff in a supportive manner. She is also prepared to take appropriate managerial action to protect residents, including disciplinary action. Barchester Healthcare has a system for regular audit of quality. Monthly inhouse audits take place relating to different areas of care, for example medication and infection control. There is a tracking system to monitor matters such as pressure damage or infections. Quality of service questionnaires take place and the results go to the parent company for auditing. Where issues are identified, the manager is required to develop an action plan. Results of audits are put in a newsletter which goes to all service users. A review of the most recent information showed a high level of satisfaction amongst respondents. Regular visits take place by a senior manager. The reports produced detail a range of matters relating to resident care. If shortfalls are identified, the home manager is required to draw up an action plan to address them. It was noted as good practice that the most recent visit took place unannounced at 5:00am so that the manager could review care at night and in the early morning and meet with staff at these times. Barchester Healthcare has a standard system for management of residents’ moneys, which the home are complying with. The home does not look after any moneys for residents. All charges for sundries such as hairdressing and chiropody are invoiced to residents’ supporters monthly. Full records of receipts are maintained, to ensure that charges can be properly tracked. Barchester undertakes annual audit of accounts and additional unannounced audits take place at times. The administrator clearly works hard to build up relationships with residents’ supporters, to ensure that items they need, such as clothing or nightwear, may be obtained. Where residents have no relatives, there are systems in place via social services for management of their monies. In such cases, staff in the home purchase items on residents’ behalf and charge items to their account. Where residents’ valuables are handed in for safekeeping, there are secure systems for storage and records relating to such items are kept in a bound book, with a full audit trail. The home operates a clear system for staff supervision. All staff, at all levels in the organisation, including ancillary staff, receive supervision six times a year. All staff receive an annual appraisal and if they need more support, additional appraisals take place. New staff receive supervision at three- and six-monthly intervals. Supervision records show that some supervisions are performed individually and others in groups, particularly where clinical issues are being explored. There are clear records to show that staff receive mandatory training in areas such as manual handling and infection control. The training coordinator has Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 27 systems in place to ensure that managers are notified if staff do not attend such mandatory training. All staff are trained in fire safety every six months and night staff receive three-monthly training. All systems relating to fire safety are regularly maintained and all required checks are carried out. All equipment is maintained and Barchester Healthcare has an effective system for ensuring that its policies and procedures relating to maintenance are carried out. Wingfield Care Home(The) DS0000032366.V313797.R02.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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 4 4 4 4 3 x 4 STAFFING Standard No Score 27 4 28 4 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 4 x 3 3 x 4 Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 17(1)S(3) (k) Requirement The registered person shall maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user: A record of any nursing provided to the service user, including a record of his condition and any treatment or surgical intervention. (This relates to where frail service users need their position changing on a regular basis, that there must be written evidence to show that this has taken place in accordance with their care plan). Timescale for action 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 30 No. 1. 2. 3. 4. 5. Refer to Standard OP7 OP7 OP8 OP8 OP29 Good Practice Recommendations Liquid paper should not be used to correct notes. Where staff are aware of the detail of care needs, this should always be documented. Records relating to a service user’s dietary intake should state what they have been given to eat, rather than just that the meal was liquidised. Care plans relating to service users with diabetes, should use precise measurable terms and avoid the use of generalistic words such as “normal”. All references should have a date on them. Ancillary staff should also have an interview assessment completed. Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wingfield Care Home(The) DS0000032366.V313797.R02.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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