Inspection on 13/12/05 for The Winsor Nursing Home

This inspection was carried out on 13th December 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Winsor Nursing Home 24/07/07

The Winsor Nursing Home 06/03/07

The Winsor Nursing Home 02/08/06

The Winsor Nursing Home 10/05/05

The Winsor Nursing Home 28/10/04

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 The Winsor Nursing Home 54 The Avenue Minehead Somerset TA24 5AW Lead Inspector Dee McEvoy Announced Inspection 13th December 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Winsor Nursing Home DS0000061582.V259107.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. The Winsor Nursing Home DS0000061582.V259107.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Winsor Nursing Home Address 54 The Avenue Minehead Somerset TA24 5AW 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) 01643 707870 Sanctuary Care Limited Mrs Amanda Susan Dorothy Ricketts Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places The Winsor Nursing Home DS0000061582.V259107.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One named person aged 45 - 64 years for General Nursing Care Three places for Respite Care for people aged 45 - 64 years, for a period of up to 28 days 10th May 2005 Date of last inspection 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 DS0000061582.V259107.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the second of the current year and took one day to complete. Standards met at the previous inspection (10/5/05) were not fully inspected during this visit, it is therefore recommended that the reports be read together to gain a full understanding of the service provided. There were 33 residents living at the home on the day of inspection and the inspector interviewed seven in depth; others were met in the communal sitting rooms, dining room and in their private rooms. Three relatives were spoken with as well as 11 members of staff, including the registered manager. CSCI comment cards were received from three residents and six relatives. The inspector toured the premises and inspected a number of records including residents’ assessments and care plans, records relating to recruitment and health and safety and a pre-inspection questionnaire. Finally, the outcome of the inspection was discussed with the registered manager. What the service does well: What has improved since the last inspection? The disposal of medicines has been addressed since the last inspection and is now safe. The Winsor Nursing Home DS0000061582.V259107.R01.S.doc Version 5.0 Page 6 Residents benefit from a homely, clean and pleasant environment. Several communal areas around the home have been refurbished to a high standard and private bedrooms on the ground and first floor have been redecorated and new carpets and furniture have been fitted. Residents spoken with were happy with the improvements. 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 DS0000061582.V259107.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 The Winsor Nursing Home DS0000061582.V259107.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): 2 This standard was met at the last inspection. EVIDENCE: This standard was not inspected but one relative commented that there had been an “efficient” assessment, followed by a “smooth admission”. The Winsor Nursing Home DS0000061582.V259107.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 Individual care plans are in place, however, a lack of consistency in detail means that some residents’ needs and preferences may not always be met. The management of medication is generally good but one area of practice could put residents at risk. EVIDENCE: Care records for six residents were looked at; whilst some were comprehensive and of a good standard, for example, good instructions were available to assist staff with managing mood swings and some behavioural issues for one resident, other care records lacked the necessary detail to ensure that individual needs were met. One diabetic resident has blood sugars checked three times a day but there was no clear rationale behind this invasive procedure and no guidance for staff as to what is a ‘normal’ range of blood sugar levels for that resident or what staff should do if blood glucose levels fall outside this range. Two nutritional assessments, one for a resident with diabetes and one with a dementia type illness, were incomplete and regular weights had not been recorded, putting these residents at some risk. Goals for daily fluid intake had not been recorded where necessary, and it was observed that one bed-bound resident was not given a drink throughout the morning of the inspection. This was discussed with staff and the manager. The Winsor Nursing Home DS0000061582.V259107.R01.S.doc Version 5.0 Page 10 None of the residents interviewed could remember discussing their care plan with staff. The management of medication was generally good; medicines are stored securely and suitable arrangements have now been made for the safe disposal of medication since the last inspection. Medicine Administration Records (MAR) were looked at; where hand written entries had been made, two signatures had been obtained to ensure accuracy, this is good practice. On two occasions, codes were not used where medicine had not been given. It was noted that one resident was not given their early morning medication until 11.45. The resident told the inspector that this was a regular occurrence; the nurse told the inspector she had been “very busy” and hadn’t managed to get back to the resident to administer the medication. The Winsor Nursing Home DS0000061582.V259107.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, 14 & 15 The social and recreational programme in the home continues to be developed. Some residents could be better encouraged and supported to exercise control and choice. A balanced diet is provided, but efforts need to be made to try to ensure it meets individuals’ preferences. EVIDENCE: The activities manager, who is keen to ensure that individual social needs and preferences are met, is developing group and individual activities. Some residents told the inspector that they were enjoying the entertainment within the home; others said that they prefer one to one activities or their own company. Two residents described the friendships developed and enjoyed since moving into the home. Two residents told the inspector that they were unhappy about the daily routine and the fact that their preferences were not taken into account; one resident was concerned that personal care was not provided until late, usually around mid-day. Another resident told the inspector they were “not allowed” to ring the bell at certain times, usually meal times. Three residents said that preferences regarding food were not always met. These issues were discussed in detail with the manager, who said she would address these concerns. The Winsor Nursing Home DS0000061582.V259107.R01.S.doc Version 5.0 Page 12 Some residents were happy with the food, and some were not. Three residents responding with comment cards and two interviewed were satisfied with the meals provided, three residents spoken with were not happy with the quality or variety of the food available. The inspector was told that the kitchen is not always willing to store or heat food brought in by family members. This was discussed with the manager and is to be addressed. The Winsor Nursing Home DS0000061582.V259107.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): 18 Residents would be better protected if all staff were familiar with local adult protection policies and procedures. EVIDENCE: Residents spoken with and those responding with comment cards said they felt safe at the home, one resident said, “They know what they are doing”. Another said, “I feel safe and confident with the care staff”. The home has policies and procedures to guide staff with adult protection issues, but two staff members spoken with, including a newly appointed carer, had not seen the policies, neither had received specific training to prevent or identify adult protection issues. However, both were aware of their responsibility to report any concerns. Where bedrails have been identified as necessary, risk assessments are completed and consent is sought from the resident where possible or a relative. A record of monthly safety/maintenance checks was seen for bedrails in use. The Winsor Nursing Home DS0000061582.V259107.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 The standard of the environment within this home is good, providing residents with an attractive, clean and homely place to live. EVIDENCE: The home is maintained to a good standard; several improvements have been made since the last inspection. All communal areas have been refurbished, creating a pleasant environment for the residents. Bedrooms on the ground and first floors have been re-decorated and new carpets and furniture have been fitted. Plans to refurbish the second floor bedrooms are in place. Residents spoken with were happy with the general environment and their own private space. All the bedrooms visited by the inspector had been personalised with photos, pictures and various pieces of furniture. The Winsor Nursing Home DS0000061582.V259107.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 29 The deployment and number of staff available is not always sufficient to meet the needs and preferences of the residents in a timely way. Recruitment procedures are not entirely robust, creating a possibility that residents’ welfare is not as fully protected as possible. EVIDENCE: The main concern for residents was the staffing level at the home, although all praised the staff for the care and attention they received. Five of the seven residents interviewed said that the home often appeared to be short of staff. Residents described the consequence of this, which included personal care being given very late in the day, little time for staff to spend with residents and having to wait at times for the attention they needed. One relative was concerned about the length of time it took staff to answer call bells but praised individual staff for the care and attention given. The inspector observed that one bed-bound resident had not been given a drink during the morning; cold tea was left until lunchtime. When questioned one nurse and one carer said that had not had time to check that all the care needed had been given. Four staff members spoken with described the ‘dependency’ level of the majority of residents as high and said that it was a struggle to meet individual needs. The pre-inspection questionnaire confirms that a high number of residents require two carers to safely undertake the care they needed. This was discussed with the manager during feedback, who said that Sanctuary Care was reviewing staffing levels. The Winsor Nursing Home DS0000061582.V259107.R01.S.doc Version 5.0 Page 16 The majority of residents said they were well cared for and that staff had a fairly good understanding of their needs. Only 6 staff members currently hold NVQ 2 or above; this falls short of the expected 50 of trained care staff within the home. In order to develop staff skills and knowledge and ensure residents’ needs are understood and met, a strategy for meeting this standard needs to be developed. The inspector looked at three staff recruitment files. Whilst two contained the documentation necessary to ensure recruitment procedures are thorough for the protection of residents, one did not contain a current Criminal Records Bureau (CRB) check. The manager was reminded that staff that have a clear Protection of Vulnerable Adults (POVA first) check must be supervised until a suitable CRB check has been received by the home. The Winsor Nursing Home DS0000061582.V259107.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): 33 & 38 Current quality assurance systems do not fully involve residents and their representatives in the running of the home. Good systems are in place to promote the safety and health of residents and staff. EVIDENCE: Sanctuary Care has a range of quality assurance measures, which are to be fully implemented. Two residents told the inspector that they had completed a quality questionnaire but they were not aware of the outcome. Both were happy at the home but had identified possible improvements. The manager is to collate responses and information and make available the ‘quality of care’ survey results. The home takes its health and safety responsibilities very seriously. A permanent maintenance person has responsibility for monthly health and safety inspections. Several records were looked at, including, fire safety, The Winsor Nursing Home DS0000061582.V259107.R01.S.doc Version 5.0 Page 18 service & maintenance certificates and the last Environmental Health report; all were satisfactory, being accurate and up to date. Thermostatic valves ensure that water temperatures are safe for residents, and all windows have been restricted and all radiators are of the low surface temperature to further reduce risks for residents. The Winsor Nursing Home DS0000061582.V259107.R01.S.doc Version 5.0 Page 19 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 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X X X X STAFFING Standard No Score 27 1 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X 3 The Winsor Nursing Home DS0000061582.V259107.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? YES 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 OP7OP14 Regulation 12(2 & 3) 15(1 & 2c) Requirement Timescale for action You must - as far as practicable enable residents to make 07/02/06 decisions with respect to the care they receive, ascertaining their wishes & feelings, by consulting them prior to writing & reviewing their care plan. [Reg 12 (2)& (3); Reg 15 (1) & (2) (c)] 2. OP27 18(1)(a) The registered person, with regard to the size of the home, the number & needs of the residents, ensure that at all times suitably qualified, competent & experienced persons are working at the care home in such numbers as are appropriate for the health & welfare of residents. This is regarding adequate staffing levels in relation to residents’ dependency levels & needs. 07/02/06 The Winsor Nursing Home DS0000061582.V259107.R01.S.doc Version 5.0 Page 21 3. OP29 19(1)b Sch 2 1-7 4. OP33 24 24/01/06 The registered person shall not employ a person to work at the care home unless he/she has obtained in respect of that person information and documents specified in paragraphs 1 to 7 of Schedule 2. This refers to the outstanding CRB. (Previous timescale of 31/05/05 not met) The registered person shall 07/03/06 establish & maintain a system for reviewing and improving the quality of care, including the quality of nursing, consulting residents & their representatives. And you must supply a copy of these reviews to the Commission, and make a copy available to residents. 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 OP8 Good Practice Recommendations It is recommended that fluid intake be better monitored; with relevant information included in care records and residents given the care they need to maintain an adequate intake. Monitoring of weight and regular nutritional screening, in individuals’ care plans should be undertaken and nursing staff should liaise with Diabetes Nurse Specialists with regard to the monitoring and care needed by diabetics at the home. It is recommended that residents always receive their medication at the prescribed times. It is recommended that action be taken to try to provide an appealing diet in respect of individual preferences. 2. 3. OP9 OP15 The Winsor Nursing Home DS0000061582.V259107.R01.S.doc Version 5.0 Page 22 4. OP18 5. OP28 It is recommended that all staff are familiar with the home’s and Local Authority’s written policies and procedures relating to protection of residents, and that staff receive appropriate training in this area. It is recommended that a strategy be developed to ensure that staff are supported and encouraged to obtain NVQ 2 or above and that timescales for meeting the standard are agreed. The Winsor Nursing Home DS0000061582.V259107.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 DS0000061582.V259107.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. 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