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Inspection on 29/09/05 for The Wingfield Care Home

Also see our care home review for The Wingfield Care Home for more information

This inspection was carried out on 29th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Wingfield cares for some residents who have highly complex mental health nursing and care needs. Some residents show restless behaviours, most cannot self-advocate, others may become angered easily and some risk becoming withdrawn. Observations made during the inspection showed that any complex behaviours, such as outbursts of anger were dealt with promptly and the residents involved assisted to calm down. Staff, particularly the activities coordinators, work hard to prevent residents from becoming withdrawn. Residents are not prevented from walking about the home if that is what they wish to do. The Wingfield offers an extensive activities programme for all residents, activities staff clearly know individual residents, their preferences and needs, in detail. Staff speak to residents in a calm and friendly manner and do not raise their voices. When staff talk about residents, they use non-judgemental language, this was also reflected in residents` records. Some staff were very enthusiastic about care provision and keen tell the Inspector of what they did to support and improve residents` lives. Residents who were able to communicate were appreciative of care provided. One person described staff as "Everso sweet and kind" another resident said that they were "very comfortable here" and a visitor said that activities staff "Do not ignore any of them and try to get them to join in as much as they can."

What has improved since the last inspection?

All seven requirements and four recommendations from the previous inspection had been addressed, one was being progressed. Care plans show much improvement, all reviewed detailed all of the resident`s care needs using precise and measurable terms. All care plans had been regularly evaluated. Where risks had been identified, care plans had been put in place to show how the individual`s risk was to be reduced. Staff now sign on a resident`s medicines administration record after residents have been given their medicine and medicines are not left unattended with the resident. Where a resident needs an injectable drug there are now clear records about this. References for individual staff are directly sourced. Stand alone heaters are not being used. Care plans which are no longer current have been archived. Lactulose is no longer included in the homely remedies policy. Issues being brought up by relatives in communication records in residents` rooms, are responded to on some, but not all occasions. Any odours observed in the home were dealt with promptly. Where mentors identify matters relating to new employees, this is documented.

What the care home could do better:

The home must ensure that all medicines administration records are completed in full and that if a resident does not take their medicine for any reason, that this is documented. Records relating to wound care should include response to treatment, including wound size, dimensions, presence of exudate and other matters. Where residents are prescribed a painkiller, this should be included in the resident`s care plan, so that response to treatment can be evaluated. Records of day-today care in residents` rooms should always be fully up-dated to reflect the care provided. Staff continue to need to review communications records and respond where indicated. The care plan of one resident, which was identified during the inspection, should be up-dated to reflect the change needed to their risk assessment.

CARE HOMES FOR OLDER PEOPLE Wingfield (The) 70 Wingfield Road Trowbridge Wiltshire BA14 9EN Lead Inspector Susie Stratton Unannounced Inspection 29th September 2005 12:45 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 (The) DS0000032366.V255044.R01.S.doc Version 5.0 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 (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Wingfield (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 Barchester Healthcare Homes Limited Mrs Linda Stella Hallett Care Home 57 Category(ies) of Dementia - over 65 years of age (57), Old age, registration, with number not falling within any other category (57) of places Wingfield (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The staffing levels set out in the Notice of Decision dated 16 January 2003 must be met at all times Up to 5 service users only may be in the age range 50 - 64 years The maximum number of service users who may be accommodated in the home at any one time is 57 4th April 2005 Date of last inspection Brief Description of the Service: The Wingfield is a care home providing nursing care for elderly people and for those with dementia or dementia related illnesses. The Wingfield has 57 registered places and is owned by Barchester Healthcare Limited. The Wingfield is situated on the outskirts of Trowbridge, a large town with good amenities. Wingfield Lodge, which is registered for 32 persons is on the same campus. The home was opened in January 2003 and was purpose built in 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 stairwells 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 is car parking on site and a bus stop 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. Mrs Hallett is also the registered manager for Wingfield Lodge. She is supported by a deputy manager, training manager, registered nurses, care staff, head chef, administrator, maintenance man and ancillary staff. Wingfield (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on Thursday 29th September 2005 between 12:45pm and 4:50pm, in the presence of Mrs Hallett, registered manager. Many of the residents in the home are not able to communicate, so the Inspector assessed residents’ responses to care by observing care provision in a range of areas across the home. The Inspector was able to converse with ten residents, two visitors and observe care for five frail residents who remained in bed. During the inspection, the Inspector reviewed the records of seven of the residents on both of the floors in detail. The Inspector also met with the deputy manager, two registered nurses, six care assistants, two activities coordinators, a chef and a domestic. The Inspector toured the home and reviewed documents and procedures, including systems and records for administration of medicines, the fire log book and complaints records. During a registration visit on 4 May 2005 to Wingfield Lodge, a range of matters relating to both The Wingfield and Wingfield Lodge were reviewed, this included personnel records, systems for administration of medicines and care planning. This showed that The Wingfield had addressed requirements from their inspection of 4th April 2005 prior to the requirement dates. What the service does well: What has improved since the last inspection? Wingfield (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 6 All seven requirements and four recommendations from the previous inspection had been addressed, one was being progressed. Care plans show much improvement, all reviewed detailed all of the resident’s care needs using precise and measurable terms. All care plans had been regularly evaluated. Where risks had been identified, care plans had been put in place to show how the individual’s risk was to be reduced. Staff now sign on a resident’s medicines administration record after residents have been given their medicine and medicines are not left unattended with the resident. Where a resident needs an injectable drug there are now clear records about this. References for individual staff are directly sourced. Stand alone heaters are not being used. Care plans which are no longer current have been archived. Lactulose is no longer included in the homely remedies policy. Issues being brought up by relatives in communication records in residents’ rooms, are responded to on some, but not all occasions. Any odours observed in the home were dealt with promptly. Where mentors identify matters relating to new employees, this is documented. 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 (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wingfield (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4: n.b. This home does not provide intermediate care. The Wingfield specialises in caring for elderly persons, many of whom have complex nursing and care needs. This inspection showed that the home can meet the needs of residents in the home. EVIDENCE: The Wingfield provides nursing and care to elderly persons who have highly complex care needs, mainly relating to dementia care. Staff at all levels are regularly trained in meeting the needs of persons with dementia. During the inspection, it was observed that staff provided nursing and care to persons with complex behaviours in an effective and supportive manner. Residents who exhibited complex behaviours had their needs addressed promptly, so that they did not distress others. Residents were free to sit in their own rooms, any of a choice of sitting rooms or to walk up and down the corridors, if that was what they wished. Comprehensive records are in place to direct staff on how to meet the needs of residents. Staff spoken with at all levels showed a detailed knowledge of the needs of their service users. Wingfield (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Residents are protected by comprehensive care plans, which direct care, are regularly evaluated and to which residents and their relatives have access. There are safe systems for storage and administration of medicines support residents, however some residents may be at risk as not all medicines administration records have been completed. In a complex area of care, staff work hard to ensure that residents’ privacy and dignity is upheld. EVIDENCE: The home have put much effort into improving standards of care planning since the previous inspection. Care plans reviewed reflected residents’ needs as observed, and directed care. The wording of care plans and daily records was non-judgemental in tone, describing actions to be taken and response to interventions. All care plans had been regularly evaluated. Care plans are kept in residents’ rooms, so that the resident, their visitors and all staff had ready access to them. One relative said that they regularly reviewed their relatives’ care plan, discussed it with staff and wrote in them when they wished about matters that they wished to be considered. All residents who are assessed as being at risk have care plans in place to reduce risk, this includes care plans on manual handling, the prevention of Wingfield (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 10 falls, prevention of pressure damage and how those at risk of poor dietary intake are to be supported. Residents who have wounds have care plans in place, which detail what dressings are to be used to manage the wound. However documentation relating to the wound’s response to treatment does not detail all areas which should be considered, such as wound dimensions, depth, presence and type of exudate. Care plans relating to residents with diabetes are clear and include all areas which need to be considered. Care plans showed that the majority of the residents experienced complex continence care needs. It was noted as good practice that none of the residents’ care needs were managed by use of urinary catheters. Residents have clear individual care plans directing staff on how to meet their mental health care needs. Records showed that residents’ GPs were regularly consulted. Relevant professionals such as the diabetic nurse and tissue viability nurse were consulted when indicated. Both registered nurses spoken with showed a detailed up-to-date knowledge of their residents’ medical and nursing needs and evidence-based practice to meet these needs. One resident who had been in a frail state at the previous inspection was noted to be much improved at this inspection, they were more mobile, less anxious and were eating better. All medicines are stored in a safe manner and clear records maintained. Systems, which conform with recent legislative changes, have been put in place for the disposal of drugs. On one floor of the home, six records medicines administration records had not been completed. Medicines administration records must be completed at the time medicines are administered to provide evidence that they have been taken in accordance with their prescriber’s instructions. If the resident refuses or is unable to take the medication, their record must state why the drug has not been administered so that the prescriber can be properly advised. One resident was prescribed a controlled drug to manage their pain. The resident’s care plan did not state why this drug was prescribed, so the effectiveness of this drug for managing the resident’s pain was not regularly evaluated with other parts of their care plan. Staff in the home work hard to ensure that residents’ privacy and dignity is maintained. This is a particularly complex area for this home, as some residents are no longer aware of their needs in this respect. Staff were observed to promptly notice complex behaviours, such as a resident walking into another resident’s room and taking some of the other resident’s personal belongings. Domestic staff spoken with were very aware of the importance of their role in noting any odours and dealing with them promptly, to ensure that resident’s dignity was respected. Wingfield (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 15 The Wingfield provides a comprehensive activities programme to support residents, with clear records in place. Visitors are encouraged and residents are supported in going out of the home. Mealtimes are a social occasion. Residents are given a choice of meals and staff are available to support residents. EVIDENCE: Residents are supported by a team of activities staff. All residents have a detailed activities assessment drawn up when they are admitted, from this a care plan is developed. Records maintained in residents’ rooms detail the activities they have been involved in. One resident described the cooking that they had done the day before and how much they had enjoyed it. Another resident said “There’s always something happening all the time”. One person said that they gave the home “full marks” for their work on activities provision. Residents who are unable or do not wish to leave their room, can have one to one support. One relative said that they appreciated this taking place for their relative. Several residents were returning from a trip out of the home in the home’s minibus towards the end of the inspection. Staff spoken with were enthusiastic about activities provision and nursing and care staff were observed to support activities staff when they could. The visitors book shows that visitors are encouraged. One visitor said that they could stay all day if they wished. Wingfield (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 12 A meal-time was observed. All residents are offered a choice of meal, additional meals are also provided, so that if a resident changes their mind when the meal is brought up, this can be a accommodated. A choice of cold and warm drinks is offered. Most residents ate their meals in one of two dining rooms, with staff observing residents to offer support when needed. The dining rooms are pleasant, clean areas. Residents sit at small round tables, which have attractive tablecloths, normal cutlery and flowers on each table. One resident was observed to cough when swallowing, this was noted quickly by a carer, who supported the resident in a kindly manner and when the carer felt they needed support from a registered nurse, this was promptly given. Residents who were able to express an opinion said that they had enjoyed their lunch, one person described the food as “very, very good”. The chef showed a detailed knowledge of what residents liked to eat and how those who may need additional support may be helped. A recent innovation is to use a dietary supplement to make muffins, rather than as a drink, which residents were reported to enjoy eating. Wingfield (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17 The home has a complaints procedure, which records and discussions indicate works in practice. Residents with complex care needs are supported by staff who ensure that vulnerable adults are protected. EVIDENCE: The home manager maintains a full record of complaints and responses to them. This includes verbal complaints and concerns raised by residents and their relatives. Records show what actions have been taken when issues are raised. One relative spoken with reported that they felt able to bring up issues of concern with any staff but if they did not receive an effective response locally, they went to see the manager, who always listened and took action to ensure that their concerns were addressed. Some of the residents in the home have complex care needs which means that they can present a risk to other residents in the home. During the inspection, raised voices were noted between some residents, this was dealt with promptly by staff, who succeeded in supporting the residents involved, reducing their anger towards each other. One resident was observed to poke a member of staff hard on their back with their finger hard. The member of staff remained calm and supportive to the resident despite what must have been a painful approach by the resident. Full records of any incidents are maintained in residents’ records. Staff are to be congratulated for their calm approach towards residents with complex needs. Wingfield (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24 & 26 The Wingfield provides an environment which meets the needs of its residents. It is well-maintained, clean and provides comfortable furniture and equipment to give residents a homely setting in which to live. All equipment needed to support residents is in place and there are safe systems for the prevention of spread of infection. EVIDENCE: The Wingfield was well maintained. All items which could present a risk to residents were securely stored. All parts of the home were clean. One area showed some odour at the start of the inspection, this was noted by a domestic before the Inspector found her and dealt with effectively. The domestic reported that they had all equipment needed to ensure the home could be kept clean and odour-free. Residents all have their own rooms, all of which have en-suite facilities. Assisted baths and WCs are available. Residents are able to personalise their rooms if they wish and pictures were seen in most rooms. Many residents had also brought in ornaments or small items of furniture with them. There is a Wingfield (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 15 large enclosed courtyard garden, which provides a safe outside space for residents. There is a choice of sitting and dining areas on each floor. Equipment is provided to support residents with physical disability. Staff were observed to competently use lifting belts to support residents with manual handling needs. A range of hoists are available. All beds are electrically profiling and variable height. Residents who are assessed as needing pressure relieving equipment have it in place. Electrically operated mattresses were set at the correct levels, according to the residents’ weight. One mattress was observed by a care assistant to be faulty during the inspection, the care assistant ensured that it was removed and a new mattress provided. There are safe systems for the prevention of spread of infection. Registered nurses reported that there was a stock of sterile packs and gloves. Care staff said that they had adequate stocks of gloves and aprons. Sluice rooms were organised and had all required equipment for disposal of waste. Wingfield (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 Residents are supported by having a full team of well qualified and motivated to staff to, meet their needs. EVIDENCE: The Wingfield is required to staff the home in accordance with a Condition of Registration set out by the Commission. They were meeting the requirements of this Condition. Each floor of the home is managed by a registered nurse, these nurses are supervised by the deputy manager, who is supported by the registered manager. A full team of ancillary staff are employed, including domestic, catering, laundry and maintenance staff. The home is supported by a team of activities coordinators and an administrator. Staff at all levels showed a detailed knowledge of the needs of their residents. Carers spoken with were keen to ensure that their residents needs were met. Registered nurses actively supported carers in providing appropriate care for residents. Wingfield (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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, 32, 33, 36, 37 & 38 The Wingfield is managed by an experienced registered nurse and manager who seeks to mange the home in a open manager, involving all members of her team, residents and their visitors. Systems for review of quality of care are in place to ensure that the home is run in the best interests of residents. Service users are supported by systems to support staff. All required records are in place. The home works to ensure the health and safety of residents, their visitors and staff. EVIDENCE: The registered manager has been the manager of The Wingfield since it opened, before this, they had several years experience of management in other care homes. Discussions about practice with the manager showed that they up-date their clinical nursing skills regularly. During the inspection, it was observed that the manager spent some time on the floors, talking with residents and staff. Two carers were observed to ask the manager to assist them with providing physical care to different residents, the carers gave the Wingfield (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 18 appearance of regarding this as a usual action to take. The manager is to be congratulated for their supportive approach in such areas, as inspections of other large nursing homes shows that some managers do not spend much time out of the office and when they do, feel that it is not appropriate for them to provide support in giving residents direct physical care. Regular meetings are held for staff at all levels. Staff spoken with said that they felt able to contribute to meetings and found them helpful. Residents clearly knew the manager and were observed to feel comfortable in their presence and able to bring up a range of issues that they wanted to talk about. The manager reported that they have an “open door” approach to managing the home. This was supported by one visitor who said that they felt able to go to the manager when they wanted to. As well as regular internal audits of care provision, an annual satisfaction survey is sent to all residents and their relatives. The annual survey has recently been sent out, the deadline for return of survey forms has not yet arrived. The manager reported that once they have all the forms returned, they will collate the information, develop action plans where relevant and publish the information in a newsletter. Some of the forms were reviewed during the inspection, of the twelve replies relating to the admission process reviewed, ten were positive and two were balanced. None were negative. With the purchase of Westminster Healthcare by Barchester Healthcare, new polices and procedures manuals have been drawn up and were observed to have been distributed to The Wingfield to support staff. A well-established supervision system is in place in the home. One newly employed member of staff commented on how helpful they had found their induction period and that they had been supported throughout the process. Staff spoken with said that they felt supported in their roles. All records examined had been properly maintained. The home maintains two records of when residents have received personal care, one at the nurses station and one in the service user’s care plan in their room. A review of records indicates that the record in the service user’s room is not always completed, for example one such record indicated that the resident had not had a wash for two weeks and another indicated that the service user had not opened their bowels at all during September. One relative reported that this concerned them as their relative could not let them know such matters. Residents also have a communications sheet for residents in the notes kept in their room, some written comments from relatives indicate that these may not be accessed by staff every day and others did not include a note of whether action had taken place after a request, for example where a carer had asked for more underwear, it would be helpful if a record had been made to indicate that this had happened. Wingfield (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 19 All equipment is regularly serviced. The home’s fire log book is properly maintained to show that proper fire safety systems are in place. One resident had particularly complex needs in relation to maintaining their safety and extensive records were in place to show how the home were ensuring that their environment remained as safe as possible. Following a recent incident, further action had been taken. While the actions taken were clear in the resident’s notes, the incident led to changes in the resident’s care plan. To ensure clarity, the care plan should have been up-dated and revised. Wingfield (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 20 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 x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x 3 3 3 Wingfield (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 21 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 OP9 Regulation 13(2) Requirement Service users’ individual medicines administration records must always be completed at the time of administration of a medicine. If the medicine is not administered for any reason, this must be documented on the same record. Timescale for action 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP8 OP9 Good Practice Recommendations Records relating to wounds should include response to treatment, including wound size, dimensions, presence of exudate and other relevant matters. Where a service user is prescribed a drug for the management of pain, this should be included in their care plan so that staff can regularly evaluate the effectiveness of the pain-relieving drug for the service user. The records of day-to-day care, which are kept in service users’ rooms, must always be fully updated, to reflect the care provided. DS0000032366.V255044.R01.S.doc Version 5.0 Page 22 3. OP37 Wingfield (The) 4. 5. OP37 OP38 Staff should ensure that they regularly review communications records in each service users’ room and respond where indicated. The care plan of one service user who was identified during the inspection should be updated, to reflect the changes needed to their risk assessment. Wingfield (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 23 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 (The) DS0000032366.V255044.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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