Inspection on 24/07/07 for The Winsor Nursing Home

This inspection was carried out on 24th July 2007.

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.

Other inspections for this house

The Winsor Nursing Home 06/03/07

The Winsor Nursing Home 02/08/06

The Winsor Nursing Home 13/12/05

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 Shelagh Laver Unannounced Inspection 24th July 2007 09:30 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.V343861.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 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 01643 707871 iverkilngenberg@sanctuaryhousing.co.uk Sanctuary Care Limited Post Vacant 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.V343861.R01.S.doc Version 5.2 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 07/06/07 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 adapted appropriately for the people who live there. There are assisted bathrooms and disabled toilet facilities. There is a spacious communal dining room and three lounge areas. 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. Fees range from £505 to £635 The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. In the past twelve months this established home has experienced problems with management and care delivery. There has been a period of uncertainty that has now resolved. A new manager Iver Klingenberg was appointed on 09/01/07 and an action plan to improve standards in the home was formulated. The home has been improving steadily since the last Key Inspection in March 2007. Two random inspections were carried out on 26/04/07 and 07/06/07 at which the inspectors saw improvements in personal care, activities and supervision and training. Two inspectors undertook this Key inspection. The visit lasted four hours. Inspectors walked around the home and talked with people in their rooms and in the dining room and sitting room. They spoke to the manager and staff. The records required were supplied by the manager who was available to answer all questions. Prior to the inspection the manager had completed an Annual Quality Assessment Audit (AQAA) that provided information about the service. Comment cards received from people in the home confirmed that people received the help and support they needed and that staff listened to them. One comment card said “In the main I feel fortunate to be at the Winsor.” Eight people told the inspectors about care at the home. All were pleased with care in the home. “Staff are kind.” Two relatives of one person said they were “very satisfied” and had “no complaints.” They said “staff are lovely, we are well informed.” The home was “like a hotel.” The manager has not been admitting people to the home during the improvement period. The home currently has 22 residents. The manager states that the home is now ready to start admitting new people. What the service does well: The manager is experienced and qualified. He has been pro-active in leading staff and developing new ways of working in the home. There is a comprehensive training plan clearly stating the training to be provided in-house from April 2007 to April 2008. This is delivered by senior The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 Page 6 staff supported by resources from Sanctuary Care. There are opportunities to attend external training events. The company has invested substantially in the home environment. It has been extensively refurbished and new windows have been installed. The position of the home affords views of the sea and hills. All rooms are of a good size some are spacious. The home is clean and cared for. All comment cards answered the question “Is the home fresh and clean ?” with “always”. There are a range of sound policies and procedures in place that are regularly up-dated. At this inspection staff were seen to be kind to people and knowledgeable about their needs and care. What has improved since the last inspection? What they could do better: There is an activities programme in place but this could be further developed to include exercise programs. Staff need to be aware of the ways in which they can enable people to make choices in daily life. For example people can chose the music playing in the sitting room. The cook informed the inspector that people could chose from a range of cold puddings “or cheese and biscuits” in addition to the cooked sweet. These choices could be presented on a trolley so that people can see and make a real choice at each lunchtime. As part of the quality assurance systems the manager needs to have a system in place to ensure the continued clinical development of trained nurses. The company must give prompt consideration to the registered managers application to CSCI. The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 Page 7 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 summary of this inspection report can be made available in other formats on request. The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a range of information available for service users and their representatives. Assessment documentation is available and there is a procedure in place. EVIDENCE: The statement of purpose is clear and has been up-dated since the appointment of the current manager. The fees range from £505 to £635 and are based on nursing needs. There have been no recent admissions to the home. There are adequate assessment procedures in place and the manager and deputy manager are skilled and experienced in assessment. The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 Page 10 The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is good. Personal care is planned and delivered in a manner that meets peoples’ needs. Medication practice is sound. Service users have access to appropriate healthcare professionals. EVIDENCE: There was evidence that fluid and nutritional intake is monitored and that action is taken to prevent pressure damage. A trained nurse talked about how the organisation of personal care delivery has changed and improved over the past months. Staff now work in pairs and there is attention to completing a persons care and leaving them comfortable before moving to another person. People seen during the inspection appeared comfortable and looked well presented. Nurses on duty during the inspection were knowledgeable and up to date with people’s needs and treatments. Three care plans were seen. Plans are now audited by the deputy manager. There was evidence of regular up-dating. The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 Page 12 There was evidence that care plans are discussed with relatives and service users. The inspector was able to meet a relative of one person being “case tracked.” There was praise for the Key Worker who kept in touch with her and she acknowledgement that life in the home was “looking up.” There were recorded doctors’ visits and evidence of reviews. There was evidence of close monitoring of epileptic conditions in a clear and effective manner. In one care plan the daily records indicated that one person had increasing mental health needs. There should be clear guidance to staff in the care plan as to how this person can be supported and reassured. The night care plan needed updating and was not reflective of the persons needs as described in the daily records. Medication administration indicated a generally safe system. Records showed the correct implementation of the Homely Remedies policy to give two doses of paracetamol. Variable doses are recorded. There are charts in peoples’ rooms that show creams are applied regularly. Staff were seen to treat people with kindness and respect. The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. People should be encouraged to make choices about their day-to-day lives. Visitors are always made welcome in the home. There is choice at meal times and people eat in a pleasant dining room. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA states that a program of activities is available. During the inspection there was evidence of recreational activities for service users. The programme of events includes activities in the main sitting room and 1:1 visits. There is a church service on Sunday. The manager has arranged training for the activities co-ordinator and there are some “special events” organised including an Hawaiian Day. The manager, activities co-ordinator and staff must work together to develop appropriate social opportunities for people according to their needs. All staff must be aware that they can contribute to the social wellbeing of service users. The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 Page 14 The home should be aware that simple measures such as considering service users when choosing radio stations or music in communal rooms can be adopted by all staff. More people appeared to be using the communal areas regularly. One person was receiving a visitor in the small sitting room. The home has satisfactory arrangements in place while it is without a full time chef. Minutes of a meeting held by the temporary catering manager showed attention to detail. The menu and observation of lunch shows there is a choice at lunch and supper. Vegetarians and special diets are catered for. There is a daily option listed of omelettes, jacket potatoes and salads. Soft diets are prepared using the same ingredients as the main meals. On the day of the inspection lunch appeared appetising and freshly cooked. A home-made cottage pie and two fresh vegetables were served. People can chose to have hot pudding, yoghurt or fruit. It is suggested that these choices are available on a trolley so that people can see clearly what is available. Visitors were observed in the home and were heard talking to staff about visits out for service users. Some visitors are in the home very regularly and felt welcomed. The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. There is a complaints policy that is clearly written and is accessible to service users and visitors. Formal complaints are addressed and actions recorded according to policy. Managers of the home are aware of the appropriate procedures to be taken to protect service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has policies and procedures in respect of recognising and reporting abuse, making a complaint and whistle blowing. Since the last inspection the home have received two complaints both of which were fully investigated and responded to. The manager is aware of the process of reporting staff to the Protection Of Vulnerable Adults (POVA) register and has done so in one instance. The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 Page 16 Service users stated that they would be comfortable to approach the manager or a member of staff if they had any concerns about their care. All new staff are checked against the POVA register before they commence work and undergo an enhanced Criminal Records Bureau (CRB) check. Staff in the home have received Protection from Abuse training. The manager should ensure that all staff are aware of the up-dated Somerset Safeguarding Adults and that appropriate training is provided to key staff. The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 Quality in this outcome area is good. People live in a clean and comfortable environment that meets their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has had windows replaced and a complete overhaul including new carpets and major refurbishment in the past year. A tour of the building showed that the considerable investment and upheaval has now resulted in a very pleasant environment for people. Housekeeping staff maintain a high standard of cleanliness even during times of staff shortage. Communal rooms are light and comfortably furnished. Bedrooms are personalised. Some of the bedrooms have excellent views of the hills or sea front. The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 Page 18 There is planned further investment in the bathrooms. There is a need to provide more outside space for people. As the dependency of people has increased the access to parks and the sea front is no longer sufficient and it important that people have a private and easily accessible outside space. The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. Staffing levels in the home are appropriate to the needs of the service users. Training opportunities are good, giving staff the skills to meet the needs of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Duty rotas showed that there were sufficient staff on duty. There is always at least one trained nurse on duty. The duty rota showed that there is a mixed team of male and female staff on duty enabling personal choice. There is a comprehensive range of training available for staff. Over the past nine months there has been an intense period of training, appraisal and supervision. There is a clear statutory training matrix for all care and support staff. Staff on duty were able to describe the training they had received recently. Inhouse training events are clearly displayed and staff are attending. Topics include Key Worker Role, Moving & Handling, Person Centred Care and Nutrition. All are linked to improving outcomes for people. The manager, The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 Page 20 deputy and two staff nurses have attended “Train the trainer” courses to deliver the Sanctuary Care induction programme. Of the 20 care staff in the home 15 either hold NVQ or equivalent qualifications or are working towards their qualifications at the moment. As the numbers of people in the home increase the trained nurses will have a key role in maintaining standards and managing care. The manager should have a plan in place to ensure good clinical practice is maintained. Four recruitment files were examined and a structured and robust process was seem. However in one file a verbal reference had been obtained but it was not evident the date it was received. There was not a comprehensive record of the conversation held. If a telephone reference is used as part of the recruitment process this should be clearly recorded and supported by a written reference as soon as possible. The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 36 37 38 Quality in this outcome area is good. There is a clear management structure in the home leading to clear lines of responsibility. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager Iver Klingenberg was appointed in January 2007 with the appropriate qualifications and experience to run the home. At the time of his appointment the home had undergone a period of instability and poor performance. He has been able to implement changes and improvements in the running of the home and improve outcomes for people in the home. Minutes of a staff meeting were seen confirming good attendance and addressing a range of issues including training, supervisions and the last CSCI inspection. The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 Page 22 It was not possible to review the annual quality assurance questionnaire that is administered by the company in September. There was evidence of a comprehensive and efficient health and safety maintenance. All servicing records reviewed at the home were up to date. Lifts and hoists had been serviced according to LOLER regulations. There are fire prevention and safety systems in place in the home. Staff training, alarm and emergency lighting checks and fire extinguisher servicing records were all clear and current. Fire drills are held regularly. It is good practice to make a brief evaluation of these drills. Currently records simply say “All staff attended.” A record of who attended and how smoothly the drill went is useful to guide further draining to ensure all staff are fully briefed. The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 Page 23 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 3 3 X 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X 3 X 3 3 3 The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP32 Regulation 8 (1) Requirement The manager must complete an application to CSCI to be registered. Timescale for action 31/08/07 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. 3. Refer to Standard OP20 OP8 OP29 Good Practice Recommendations The external space at the home should be reviewed in order to provide an area that is accessible and suitable for service users. Where applicable the care plans should include clear assessment of mental health and guidance for peoples’ psychological care. If a telephone reference is used as part of the recruitment process this should be clearly recorded and supported by a written reference as soon as possible. The Winsor Nursing Home DS0000061582.V343861.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V343861.R01.S.doc Version 5.2 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. 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