Inspection on 04/04/05 for The Wingfield Care Home

This inspection was carried out on 4th April 2005.

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

The inspector 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 12/09/06

The Wingfield Care Home 29/09/05

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 (The) 70 Wingfield Road Trowbridge Wiltshire BA14 9EN Lead Inspector Susie Stratton Unannounced 4th April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wingfield (The) Version 1.10 Page 3 SERVICE INFORMATION Name of service Wingfield (The) Address 70 Wingfield Road Trowbridge, Wiltshire BA14 9EN 01225 771550 01225 771559 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Gregory Alan Swire Barchester Healthcare Homes Limited Mrs Linda Stella Hallett Care home with nursing 57 Category(ies) of DE(E) Dementia - over 65 (57) registration, with number OP Old Age (57) of places Wingfield (The) Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users who may be accommodated in the home at any one time is 57. 2. Up to 5 Service users only may be in the age range 50-64 years. 3. The staffing levels set out in the Notice of Decision dated 16 January 2003 must be met at all time. Date of last inspection 3rd September 2004 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. 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 ensuite 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. She is supported by a deputy manager, training manager, registered nurses, care staff, head chef, administrator, maintenance man and ancillary staff. Wingfield (The) Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place in the presence of Mrs Linda Hallett, registered manager. During the inspection, a tour of the building took place and a lunch-time meal observed. The deputy manager, training manager two registered nurses, four care assistants, two laundresses, the chef, a catering assistant and the administrator were met with. Staff showed a detailed knowledge of the needs of service users. Eighteen residents were spoken with and the care of a further eleven residents who were unable to communicate, was observed and three visitors met with. Ten of the residents were reviewed in detail, including their documentation and discussion of their care needs with staff. What the service does well: What has improved since the last inspection? A new chef has been appointed, she reported that she is trying to further develop flexibility in her service, as many of the residents with short term Wingfield (The) Version 1.10 Page 6 memory loss find it difficult to plan ahead about what they would like to eat on the next day. The chef is available in the home at lunchtimes to observe meals and receive comments from residents and visitors. One of the first floor sitting rooms has been kitted out as a bar and a licence obtained for its use. Residents are currently using it two evenings a week. Coffee mornings are also held in the room on two mornings a week. A full action plan was received following the last inspection. Mrs Hallett and her deputy have continued to develop the audit system for care plans as was required at the previous inspection and good practice was noted for some care plans, particularly in relation to complex behaviours. Registered nurses are now consistently recording the date of opening on limited life medicines. The name of the mentor for new employees is now included in training files. Care staff have been supported in completing accident forms themselves, so that accidents are documented by the person who witnessed the accident. What they could do better: As noted above, care plans are improving but the improvement is variable and while some very good examples were seen, some unclear care plans, which did not direct care, were observed. Staff need to concentrate on clearly describing care needs in precise terms. Up-dates of care plans to reflect changing care needs are taking place, however, again this was not consistent across the home. For some residents where risk was identified, care plans were in place to reduce risk, however this was not the case for all residents and on one occasion a care plan to reduce a risk was not being followed by staff. Staff need up-to-date care plans so as to direct them on how to meet residents’ needs. Care plans must always be followed to ensure that residents’ needs are being met. Administration of medicines generally met guidelines and showed good practice in some areas, however there was one case of a medicine being signed for and left with a resident before administration was completed. If medicines are left unattended with a resident, in a care home specialising in dementia, there is always a risk that another resident may take the medicine. On one occasion a drug was being stored for use in an emergency but the service user’s medicines’ administration record no longer had the drug documented. This service user would be at risk of not being given the drug in an emergency. Progress has been made in ensuring that required checks are carried out for prospective employees, however the agency who supplies some employees continues not to supply the home with correct references. The home cannot verify a member of staff’s suitability without correctly obtained references. One service user was found to have a stand-alone heater, this is contrary to fire prevention policies. Please contact the provider for advice of actions taken in response to this Wingfield (The) Version 1.10 Page 7 inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Wingfield (The) Version 1.10 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Wingfield (The) Version 1.10 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 4 5 Residents’ nursing and care needs are fully assessed prior to admission and the home demonstrated that it can meet these care needs. Visiting by supporters is encouraged, to help frail persons in making the decision on whether to move into the home. EVIDENCE: Most residents admitted have complex dementia care needs and need nursing care. All persons’ nursing and care needs are assessed by a senior member of staff prior to admission. Due to their frailty, most of the service users cannot visit the home prior to admission. One relative said that they had asked a younger relative of theirs to visit on their and their relative’s behalf. Another resident had been admitted for respite care previously and when they needed care, The Wingfield was a familiar place for them to be admitted permanently. Staff showed that they knew this person’s needs. Many of the residents experience complex behaviours and it was observed during the inspection, that these persons were able to walk where they wished in the building, sitting where they chose, with staff observing them, to ensure their safety. There was a relaxed atmosphere and while some residents showed noisy and restless behaviours, none continued for an extended period and no persons showed overt signs of distress. Wingfield (The) Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 8 9 10 11 Standards of care planning are variable, some show high standards, others do not. Inadequate care plans for certain residents could put them at risk. Staff demonstrated a sensitivity in meeting the needs of confused and frail residents. Most matters relating to medicines administration were met, but some attention is needed in two specific areas, to ensure service user safety. EVIDENCE: The standard of care planning is variable, some very high standards were observed, three residents had very clear care plans on the management of their behaviours and one had a clear care plan on the use of an aide. Other care plans were not clear, one diabetic service user had a generalistic care plan which did not direct how their condition was to be monitored and diabetic care needs met, two other care plans described the resident as showing “aggressive” behaviours, but did not document what these behaviours were or how needs were to be met. In the absence of full care plans, service users with complex care needs could be put at risk. Residents who had continence care needs had care plans in place. A new continence aid, which was more discrete and acceptable had been introduced. Three residents had bowel care needs, their daily records had been sparsely completed for March, one person had only had one entry for all of March, Wingfield (The) Version 1.10 Page 11 although they were documented as being at high risk of constipation. Regular monitoring of responses to care plans must take place to ensure that the resident’s needs are being met. All residents are assessed for risk of pressure damage. Seven residents were assessed as being at risk of pressure damage, of these three had care plans in place to indicate how risks were to be reduced. One resident did not have a care plan and was not provided with appropriate equipment to prevent pressure damage, in accordance with their assessed risk and their care plan did not reflect what was observed. Service users who are at risk of pressure damage need full care plans in place, to ensure that pressure sores are prevented. Two of the residents had wounds which needed regular ascetic dressings. Care plans directed care and records clearly demonstrated the wounds’ responses to treatment. Staff appeared to know the needs of residents. One resident spoken with was relaxed, but also used abusive language. Staff spoken with showed a clear understanding of this resident’s behaviours and how to manage the care of this person, so as not to increase the abusive language. Very frail residents who were nursed in bed were properly cared for, they had clean night clothes and bedding, their hair was brushed and their skin indicated that they were well hydrated. Where residents showed flexion contractures, their skin creases were clean. Most care plans were reviewed regularly. One resident’s condition had deteriorated recently and their care plan had been regularly reviewed to reflect their changing care needs. However another resident had not had their care plan evaluated since January although their daily record indicated that they had some changing needs. If care plans are not up-dated, staff will not be aware of how to meet changed needs. Many of the residents are not able to discuss their needs with staff, where this is the case the home consults with relatives and many of the care plans and risk assessments had been signed on the resident’s behalf by a relative. One relative said that the home kept in regular contact with them and always informed them of any change in their relative’s condition. Two service users notes showed care plans which were no longer relevant, they need archiving, to prevent confusion for staff. It was noticed as good practice that the domestic staff routinely knocked on residents’ doors and asked permission to clean their rooms and en-suite facilities. One of the laundresses was going through the clothes of a newly admitted person, to ensure that all unmarked items were identified and then asked the person’s permission to remove the items and take them for marking. Wingfield (The) Version 1.10 Page 12 Two medicines rounds were observed, the registered nurses were observed to take care to perform their duties in an unhurried and careful manner. All medicines were stored safely, in accordance with current guidelines. None of the residents are assessed as able to self-medicate. Both of the registered nurses showed a good knowledge of the medicines they were administering and if they were unsure, they referred to the British National Formulary. One resident reported that they had been prescribed two new drugs the previous week and that they had reacted badly to them. They said they had been impressed with how quickly the registered nurse had noted the change in their condition and acted to inform their GP and have the drugs discontinued. On one occasion it was noted that a liquid medicine had been halfadministered and signed for but the half-administered medicine remained with the resident for more than one hour. This is a risk, as some of the residents have a tendency to wander into other residents’ room and they might inadvertently have taken the medicine. One resident who might need the administration of a medicine by injection in an emergency, no longer had it documented on their MAR sheet, although stocks were held in the home. If administration was needed, the registered nurses did not have evidence that the drug continued to be prescribed and might not give it in an emergency. Lactulose continues to be included on the homely medicines list. It was recommended at the previous inspection that this be removed, as Lactulose needs to be given regularly to be effective. Wingfield (The) Version 1.10 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 13 14 15 There were high standards in meeting residents’ recreational needs, both in and out of the home. Mealtimes are seen as a central part of provision of social care. Residents with dementia care needs are supported in continuing social activities and are assisted in maintaining contact with other persons, reducing isolation and improving general well-being. EVIDENCE: Three activities staff are employed and a wide range of activities are offered to residents with different needs. Some activities are in large groups, others in smaller groups and some as one-to-one activities. All residents have a care plan detailing their needs and preferences for activities. Records of activities participated in are completed on a daily basis. One resident said that they experienced depression and at times did not wish to become involved, they said that staff encouraged them to join in, but respected their wishes not to become involved. They said that they appreciated activities staff continuing to try to involve them when they felt able, as they enjoyed the activities. One resident said how much they enjoyed the religious services and listening to the hymns. The home owns a minibus and residents are assisted to go out of the home. One of the residents commented particularly on how they were looking forward to more trips out in the nicer weather. Visitors are encouraged at any time. Each resident has a communication record in their room, which visitors and Wingfield (The) Version 1.10 Page 14 key workers can complete if they wish. Some of the records examined showed a range of communications between the key worker and relatives, however one record showed that the relative had raised issues, to which the key worker had not always responded. The home tries to encourage choice as much as possible. One resident said that they had wanted to hold the key to their room and that they had been helped in doing this, but after they had lost their key several times, this had been discussed again and they had decided that it was probably safer not to hold the key to their room. Several residents showed short term memory loss and concentration difficulties, staff were observed supporting them in deciding where they would like to spend the day and what they would prefer to do. Observations of a lunchtime was included in the inspection. Residents ate in one of two dining rooms or in their own room. The home tries to make meal times a social occasion, with residents eating at small round tables with tablecloths and flowers on tables. The chef observes meals to ensure that residents’ preferences are met, she also meets with residents regularly to hear their opinions. One person said that they had told the staff that they would like to have salads and that they are now given a salad when they wanted one. Three residents and one relative described meals as being “very good”. One person said “I let them know what I want for my meal and I get it”. Where residents need assistance to eat their meals, care staff sit with them, encouraging and supporting them in eating. It was noted that care staff maintained close observation of residents in the dining room, noting if a resident had stopped eating or was showing restless behaviours, reminding them to eat and helping them if they were finding difficulty with concentration. This was all done in a quiet, unobtrusive manner. Wingfield (The) Version 1.10 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 18 A complaints procedure is in place, which works in practice, to support persons if they have concerns. Many residents show complex care needs, systems are in place to protect residents and make them feel safe. EVIDENCE: Residents who were able to communicate said that if they were concerned about anything, they would bring it up with the staff. One of the residents, who found some difficulty with communicating, was aware how the complaints process worked in the home. One resident commented on how staff listened to what they said, another said “I go to the boss [meaning the deputy manager] if I’ve a problem” and another “If I’m not happy with anything I tells the staff and they sorts it”. One resident said that they had been concerned as an article had gone missing that morning, they stated that staff had taken their concerns seriously, noted it down and were looking for it. One complaint was received by the Commission about the home since the previous inspection. It was investigated, with the full co-operation of the home’s management, and was not up-held. Many of the residents experience complex behaviours, some of which result in aggression, at times towards other residents. Aggressive behaviours are documented by staff and action taken to ensure residents safety. Unexplained bruising was documented and investigated. The home have experience of working within the local vulnerable adults procedure. One resident commented on how safe they felt in the home, they reported that at times confused residents could wander into their room, but all they had to do was to ring their bell and staff came and sorted the situation out. Staff spoken with all had knowledge of how to manage residents’ with complex behaviours. Wingfield (The) Version 1.10 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 20 21 22 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. EVIDENCE: Wingfield (The) Version 1.10 Page 17 The home was well-maintained throughout. Areas needing maintenance are documented and addressed promptly. Two small areas, which were noted during the inspection, were already known to the maintenance staff and plans were in place to address them. A wide range of communal rooms of differing sizes are available to service users and a safe courtyard garden can be used in warmer weather. A sitting room has been up-graded to provide a bar and coffee room. The number of toilets and bathrooms exceed minimum standards, all are suitable for disabled persons. Grab rails and other aids are provided in corridors, bathrooms, toilets and communal rooms. Doorways are an adequate width to allow wheelchair access. There is ample storage space for equipment. A wide range of different hoists to aid manual handling are available and staff were observed to use the equipment competently. All beds and chairs are provided with mattresses or cushions to meet the needs of persons with a medium risk of developing pressure damage. All beds are electrically profiling, they are wooden and domestic in tone. Residents said how comfortable their beds were. One resident commented on how quick staff were in responding when they used their call bell. Another resident said that they did not use their call bell, but they shouted if they needed help and that staff came quickly when they called. One resident who had a communication difficulty had been provided with a relevant aide and a care assistant was using it competently. All residents are accommodated in single rooms and they are able to bring in items of their own, some rooms were highly personal, reflecting the individual’s likes and preferences. One resident had a bookcase and desk in their room, another had a cabinet for ornaments, most had a range of photographs and pictures. The home was clean throughout, with no dust observed on high surfaces or under beds. All bath hoists and raised toilet seats were clean on their undersides. Some of the corridors on the ground floor were mildly odorous, Mrs Hallett reported that this related to behaviours by a few residents, where effective management programmes had not yet been put in place. The laundry was clean throughout and both laundresses showed full appreciation of the importance of attention to infection control procedures. Wingfield (The) Version 1.10 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 29 30 A full range of staff with a skill mix to meet service users’ needs are in post. Staff recruited by the home have full pre-employment checks, however the agency used by the home to recruit other staff do not ensure that suitable references are sought, thereby putting residents at risk from unsuitable appointments. The training officer has a comprehensive training programme, to ensure that staff are competent to perform their roles. 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 Mrs Hallett. A range of senior care and care staff are in post. Where care staffs’ first language is not English, arrangements have been made with a local college to improve and develop their language skills. A full team of ancillary staff are employed, including domestic, catering, laundry and maintenance staff. A new chef had been employed since the last inspection. The home is supported by a team of activities coordinators and an administrator. Staff at all levels showed a sound knowledge of the needs of the service users they were caring for. The files of two recently employed staff showed improvements from the previous inspection, in that nearly all relevant documents are now supplied, but references continue to be “two whom it may concern” and not written directly to the home or Barchester Healthcare. This was identified at the Wingfield (The) Version 1.10 Page 19 previous inspection, Mrs Hallett agreed to write to the agency who supplies staff from abroad again on this matter. The training manager maintains comprehensive files on all staff. Staff are given an induction on commencement of employment and allocated to a mentor to supervise them. It was discussed that as mentors may discuss new employees’ progress, that this should be documented as well as reporting verbally, to support the new member of staff and training officer. When staff have completed their induction programme, they are encouraged and supported to commence NVQ training. A wide range of other courses are offered to staff, the most recent was the management of dementia care. Wingfield (The) Version 1.10 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 38 Mrs Hallett is an experienced registered nurse and manager who is able to lead a team of staff to meet residents’ needs. Two areas relating to health and safety were identified as they pose an element of risk for service users. The systems to ensure heath and safety are otherwise fully satisfactory. EVIDENCE: Mrs Hallett has been the manager of The Wingfield since it opened, before this, she had several years experience of management in other care homes. She ensures that she up-dates her clinical nursing skills regularly. During the inspection she was happy to discuss a range of matters in a open manner. Mrs Hallett is supported by a deputy, who is responsible for overall day-to-day clinical care. The home do not look after any moneys for service users. The fire log book was fully up to date, with all regular checks on fire safety equipment and training taking place. One resident had a stand-alone heater in Wingfield (The) Version 1.10 Page 21 their room. Such heaters, if required, must be fixed to the wall, due to the established fire risks of the use of such heaters in care homes. One resident was prescribed oxygen. The cylinder was safely secured and all required safety signage was placed on the resident’s door door. Systems are in place to ensure staff attendance at mandatory training in areas such as fire safety, manual handling or infection control. To support night staff, the training manager regularly provides mandatory and other training in the late evening. It was noted as good practice that all cleaner’s cupboards, sluice rooms and bathrooms, which could present a risk to residents with dementia, were locked. Accident records were properly completed by the person who witnessed or first observed the accident. There was evidence of follow-up when necessary. All residents are regularly assessed for risk and care plans put in place to reduce risk. Two of the residents with were assessed as being at risk of falls, one had a clear care plan to reduce risk, the other had a care plan, which stated that the person must wear well-fitting shoes or slippers. This residents’ slippers did not fit properly. Wingfield (The) Version 1.10 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 4 4 4 3 4 x 3 STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x N/A x x 2 Wingfield (The) Version 1.10 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15(1) Requirement All care plans must detail all care, including nursing, to meet service users care needs. Wording used must clearly describe needs and interventions, in precise and measurable terms. All care plans must be regularly evaluated and revised when a residents condition changes. If risks are identified, a care plan must be put in place detailing how that individuals risk is to be reduced. Staff must ensure that the directons on care plans are followed, or the reason for it not being followed is documented. Staff must not sign a residentss MAR sheet until they have taken all of their medicine. Medicines must not be left unattended with a resident. Evidence must be available to show that where a resident may need an injectable drug, which may be required in an emergency, that this is documented on the MAR chart or if it is no longer needed, that the drug has been disposed of. All references for potential Version 1.10 Timescale for action 31 August 2005 2. 3. 7 8, 38 15 (2)(b)(c) 13(4)(c) 15(1) 31 August 2005 31 August 2005 4. 9 13(2) 30 April 2005 5. 9 13(2) 30 April 2005 6. 29 17(1)(2) 30 June Page 24 Wingfield (The) scedule4 (6)(c)19 (2)(4)(b) (i) scedule2 (5) 7. 38 23(4)(a) employees must be directly sourced. To whom it may concern references are not acceptable. (Parts of this requirement were identified at the previous inspection, with a completion date of 31st October 2004. All other areas from the requirement in the previous inspection have been addressed, so the home have been given more time to complete this part of the requirement.) Stand-alone heaters must not be used. If supplementary heating is needed, it must be fixed to the wall. 2005 30 April 2005 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 7 9 Good Practice Recommendations All care plans which are no longer current should be archived, to prevent confusion for staff. Lactulose should not be included on the homely remedies policy. (This recommendation was identified at the previous inspection.) Where issues are brought up by relatives in communication records, outcomes should always be documented. (This recommendation was identified at the previous inspection.) Care plans to meet the needs of service users with inappropriate urinating should continue to be further developed, to prevent the development of odour in parts of the home. Where mentors identify matters in relation to new employees, this should be documented. 3. 13 4. 26 5. 30 Wingfield (The) Version 1.10 Page 25 Commission for Social Care Inspection Suite C Avonbridge House Bath Road Chippenham Wiltshire 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) Version 1.10 Page 26 - 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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