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Inspection on 10/05/05 for The Winsor Nursing Home

Also see our care home review for The Winsor Nursing Home for more information

This inspection was carried out on 10th May 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

Service users spoken to during the inspection stated that staff were kind. The direction and support given by Sanctuary Housing is becoming apparent at the home. Policies and procedures have been introduced and there is a supportive infrastructure of regional and head office staff. There are plans to invest substantially in the home in the coming months. The regional manager visits the home at least every two weeks. The manager is experienced and is pro-active approach in accessing specialist treatments and services. Training for management, nursing and care staff is organised. The manager takes appropriate action to ensure that admissions take place following a comprehensive assessment of the service users needs. Service users benefit from a safe, clean and pleasant environment. Service users spoken to liked living in the home and felt well cared for. Service users stated that the food was enjoyable. One service user said that staff tried hard to make sure that all service users enjoyed their meals and had individual choices when necessary. Another service user was not happy with the food and action had been taken by the manager and chef to address the concerns. The home takes appropriate steps to ensure the health and safety of the service users, staff and visitors. The staff group has stabilised and few agency staff are used.

What has improved since the last inspection?

Amendments have been made to the medicine storage. Sanctuary policies and procedures have been fully implemented. Training has been provided to trained staff. The manager is now supernumerary and receiving support to become familiar with the company procedures and systems.

What the care home could do better:

Care plans need up-dating to reflect service users changing needs. Details of care and health changes are recorded in the daily record and not transferred to the main care plan. The home has access to a comprehensive and thorough set of recruitment policies and procedures. However at the inspection it was clear that the method of accessing POVA First checks was not being followed. There is a schedule of supervision meetings planned. These are not always up to date.

CARE HOMES FOR OLDER PEOPLE The Winsor Nursing Home 54 The Avenue Minehead Somerset TA24 5AW Lead Inspector Shelagh Laver Unannounced 10th May 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. The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Winsor Nursing Home Address 54 The Avenue Minehead Somerset TA24 5AW 01643 707870 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) Sanctuary Care Limited Mrs Amanda Susan Dorothy Ricketts Care Home with Nursing 43 Category(ies) of Old Age (43) registration, with number of places The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named person aged 45 to 64 years for general nursing care. 2. Three places for respite care for people aged 45-64 years, for a period of up to 28 days. Date of last inspection 28th October 2004 Brief Description of the Service: The Winsor Nursing Home provides nursing care for 43 persons over the age of 60 years. The home is situated in Minehead, a short walk from the seafront. The accommodation is arranged over three floors serviced by a passenger lift. The accommodation is provided in 38 bedrooms that include 33 single en-suite rooms. The home is well adapted for the service user group. There are assisted bathrooms and disabled toilet facilities. There is a spacious communal dining room and three lounge areas. There is an activities organiser and a weekly programme of events. A Registered General Nurse is on duty at all times and links are made with a network of health services to meet service users needs. The home has been owned by Sanctuary Care Ltd. since 27th July 2004. The home has a block contract for 14 beds with Somerset Social Services. The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 1 day and was conducted by two inspectors Shelagh Laver and Barbara Ludlow. A tour of the premises took place where most of the bedrooms and all of the communal areas were seen. Twelve service users and six staff were spoken with. The registered manager was available in the afternoon to assist the inspection. On arrival at the home there was an ordered homely atmosphere. Two registered nurses were on duty. Records relating to care, staff and health and safety were examined. What the service does well: Service users spoken to during the inspection stated that staff were kind. The direction and support given by Sanctuary Housing is becoming apparent at the home. Policies and procedures have been introduced and there is a supportive infrastructure of regional and head office staff. There are plans to invest substantially in the home in the coming months. The regional manager visits the home at least every two weeks. The manager is experienced and is pro-active approach in accessing specialist treatments and services. Training for management, nursing and care staff is organised. The manager takes appropriate action to ensure that admissions take place following a comprehensive assessment of the service users needs. Service users benefit from a safe, clean and pleasant environment. Service users spoken to liked living in the home and felt well cared for. Service users stated that the food was enjoyable. One service user said that staff tried hard to make sure that all service users enjoyed their meals and had individual choices when necessary. Another service user was not happy with the food and action had been taken by the manager and chef to address the concerns. The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 Page 6 The home takes appropriate steps to ensure the health and safety of the service users, staff and visitors. The staff group has stabilised and few agency staff are used. What has improved since the last inspection? 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. The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 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 standard(s) 1, 2, 3, 4, 5. Standard 6 does not apply as the home does not supply intermediate care. The manager ensures that the home can fully meet the assessed needs of the prospective service users prior to making a decision about admission. The assessment and admission process is comprehensive and well managed. EVIDENCE: The home has produced a Statement of Purpose and service User guide which is made available to service users and prospective service users. Contracts and terms and conditions were observed for three recently admitted service users. The contracts showed clearly the break down of responsibilities of parties for the fees. The contribution of the nursing care element to the overall fee was clearly shown. Extra charges are made for personal toiletries hairdressing, chiropody and newspapers when applicable. The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 Page 9 The manager ensures that prospective service users are fully assessed and when possible are invited to visit the home. Files contained assessment documentation from nurse assessors and other professionals that had contributed to the assessment. The manager stated that whenever possible a service user visits the home prior to admission. In some instances the service user may be admitted from hospital and may be too ill to visit. Relatives are welcome to visit for the service user. The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 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. The home takes appropriate action to ensure that the health care needs of the service users are met. The home’s procedure for the management and administration of medication is safe and effective. Staff must review and up-date care plans to reflect current needs of service users. The dignity and privacy of service users is considered by staff and is supported by care practice. EVIDENCE: Individual care plans are maintained for all service users. Six were examined by the two inspectors. Care plans use SHARP documentation and are compiled from appropriate assessments which include pre-admission assessments, prevention of pressure sores, moving and handling needs, nutrition and dependency. Manual handling assessments did not always reflect service users current needs. Some care records had a review date that was long overdue. There is documentation to show that bedrails are checked monthly but this was not always confirmed by records. The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 Page 11 All service users have access to appropriate health care professionals and the manager ensures that the health care needs of service users are met. The home liases with other health care professionals to meet individual needs and evidence of correspondence was seen in care plans. The homes procedure for the management of medication was observed. Most records examined were appropriately completed. There were a small number of gaps in the MAR sheets. The home needs to check the new guidance on disposal of medicines in nursing homes with the supplying pharmacist. Staff were observed and heard interacting with service users. They spoke appropriately and closed doors during care provision. The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 Page 12 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. The home provides a wholesome and varied menu which takes into account the needs and preferences of service users. Arrangements for service users to maintain contact with family and friends is good. There is continual development of the social and recreational programme in the home. EVIDENCE: All service users spoken to during the inspection were happy at the home and felt it met their individual needs. Service users were able to describe a range of different routines in the home that allowed them some control over their lives. One visitor confirmed they were welcome to visit at any time. Service users described their enjoyment at visiting gardens and the sea front with families The inspectors met the newly recruited activities manager who works with individual service users and organises group events. Records in care files relating to social activities listed time spent with the service user. The manager commented that service users enjoyed the home made soups and puddings produced by the chef. Service users spoken to were satisfied The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 Page 13 with the food. Meals are served both in service users’ rooms and in the dining room. The tables in the dining room were pleasantly set and there was a congenial atmosphere although some people waited a long time between arriving in the dining room and receiving their lunch. The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 Page 14 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, 17, 18. The complaints procedure in the home is in place with evidence that the views of service users are listened to and acted upon. The recruitment procedures of the home are designed to protect the service user and comply with minimum standards when followed correctly. EVIDENCE: The home has a complaints procedure which is clearly displayed in the home. Copies are found in the Statement Of Purpose and Service User guide and are displayed throughout the home. There have been no formal complaints. Informal concerns are recorded and addressed by the manager. Service users had been offered the opportunity to vote including postal votes. The home has a Whistle Blowing Policy. Sanctuary care has a comprehensive system of recruitment procedures including examples of good practice such as a job profile for staff showing competences required. On the day of the inspection there was no evidence that POVA checks had been completed on two staff whose files were inspected. There was evidence of CRB checks having been completed some time after the staff had begun working at the home. Further discussions with the manager and area manager demonstrated that systems were in place to access POVA First checks but had not been accessed. This has now been corrected. The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 Page 15 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, 23, 24, 25, 26. Service users live in a comfortable and clean environment and are able to personalise their bedrooms. The home’s environment is able to meet the assessed needs of the service users. The home provides specialist equipment to ensure the needs of service users are met. EVIDENCE: The home was clean and tidy on the day of inspection. The gardens were attractive and full of colour. There is a limited amount of outdoor space for service users. There is considerable investment planned in the home and the inspector observed colour charts showing the possible decoration options. All communal areas and a selection of bedrooms were seen at this inspection. Bedrooms were pleasant and comfortable. Some bedrooms are very large and some prefer to spend a considerable amount of time in their room. The inspector spoke with members of the housekeeping staff who demonstrated a commitment to maintaining high standards of cleanliness in the home. Specialist beds and pressure relieving equipment were seen in place The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 Page 16 when needed. There is organised management of the manual handling equipment. The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 Page 17 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, 28, 29, 30. The home had sufficient staff on duty on the day of inspection. The combination of trained staff, carers and support staff enabled the home the service users and home to be well cared for. A programme of training contributes to staff competence. EVIDENCE: The staff on duty on the day of inspection were those recorded on the duty rota. The duty rota showed consistent numbers of regular staff. Service users confirmed that staff were kind and attentive to their needs. Staff were able to confirm that training had been provided in Dementia Care and further sessions were planned. There is a well organised in-house training programme that includes Manual Handling Fire, Health and Safety and Infection Control up-dates. Staff are paid to undertake all training. There is support for trained staff from the company clinical nurse specialist who is able to advise on specific issues and to provide training sessions on current issues. An up-date on the care planning system had been booked. Staff were accessing an open learning programme on Infection Control. The NVQ programme is continuing and is progressing well. The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 Page 18 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, 32, 33, 34, 35, 36, 37, 38. The home is effectively managed by the registered manager who promotes a clear and inclusive style of management. The homes systems for ensuring health, safety and welfare of service users and staff. Financial systems are in place to ensure the protection of service users and the efficient running of the business EVIDENCE: The registered manager is Amanda Ricketts who is an experienced nurse and manager. She is very much a “hands on” manager who has a clear understanding of the needs of service users living at the home. She is active in communicating with staff, service users and their families. A system of appraisals and supervision has been developed and needs further implementation. The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 Page 19 There are now comprehensive systems in place to maintain health and safety. These rely on the commitment of the house maintenance staff working within the Sanctuary Health and safety audit. Servicing labels and maintenance checks for hoists and the lift undertaken in accordance with LOLER regulations. In house weekly fire alarm tests are carried out, the record for these checks were seen. The emergency lighting and smoke detectors are checked on a monthly basis. Bath hot water temperature checks are carried out on a weekly basis. The hot water outlets are thermostatically controlled. All radiators are of the low surface temperature type. Financial records inspected were organised and clear. The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 3 3 x 3 3 3 3 3 The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 Page 21 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 OP29 Regulation 19 (b) Requirement All new staff are confirmed in post following completion of a satisfactory check of the Protection of Vulnerable Adults register. The home must ensure all handwritten prescriptions have two signatures and that there are no gaps in the MAR sheet records. Care staff must ensure that all service users can reach their care bells. Timescale for action completion by 31/05/05 1/7/05 2. OP9 13 (2) 3. 4. OP22 13 (b) (c) 31/05/05 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. Refer to Standard OP9 Good Practice Recommendations The home should confirm arrangements for the disposal of Prescription Only medicines with the supplying pharmacist. The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton, TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Winsor Nursing Home D53 - D02 S61582 The Winsor V224616 100505 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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