Inspection on 04/01/06 for Wade House

This inspection was carried out on 4th January 2006.

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

Wade House 25/07/07

Wade House 18/08/06

Wade House 07/02/05

Wade House 11/08/04

Wade House 26/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Wade House Wade House Violet Hill Road Stowmarket Suffolk IP14 1NH Lead Inspector Jo Govett Unannounced Inspection 4th January 2006 10.45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wade House DS0000037227.V275909.R01.S.doc Version 5.1 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. Wade House DS0000037227.V275909.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Wade House Address Wade House Violet Hill Road Stowmarket Suffolk IP14 1NH 01449 626250 01449 626250 karen.curle@socserv.suffolkcc.gov.uk 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) Suffolk County Council Ms Karen Curle Care Home 30 Category(ies) of Dementia (8), Old age, not falling within any registration, with number other category (22) of places Wade House DS0000037227.V275909.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2005 Brief Description of the Service: Wade House is a Residential Care Home providing personal care and accommodation to 30 older people. It is registered to provide care for eight people with dementia and twenty-two older people over the age of sixty -five. The home is owned and managed by Suffolk County Council. It is situated in the town of Stowmarket in a residential area with shops and other local amenities nearby. The home is purpose-built on two floors, which are accessed by stairs or by passenger lift. Externally there are two garden areas and a two parking areas. One garden is directly accessible to service users accommodated within the dementia care unit. All bedrooms are single occupancy with no en-suite facilities, seven bedrooms have under 10 square metres usable floor space. Wade House DS0000037227.V275909.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on the 4 January 2006. We spoke with staff, residents, the Registered Manager, Karen Curle, Deputy, Julie Tooke and Team Leaders. We looked at a variety of documentation and looked around all areas of the home. The previous inspection had highlighted a need to improve record keeping and documentation across the National Minimum Standards. Care planning; risk assessments and reviews had to be fully completed, to evidence that the needs of residents are being continuously met. We looked at the progress of this and completed inspecting the Key Standards. It is therefore recommended that any reader of this report should also see the previous report completed on the 6 September 2005. What the service does well: What has improved since the last inspection? What they could do better: The home needs to continue with the programme of updating information, and ensuring that records are correct and up to date. The medication policy and procedure needs to be updated to accurately reflect the practice in the home. It is currently a generic document provided by Wade House DS0000037227.V275909.R01.S.doc Version 5.1 Page 6 Suffolk County Council called “Instructions for Administration and Disposal of Medicines in County Council Residential Homes For Older People 2002” 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. Wade House DS0000037227.V275909.R01.S.doc Version 5.1 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 Wade House DS0000037227.V275909.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 (Standard 6 is not applicable) Residents can expect the home to meet their needs and act appropriately if their needs increase. EVIDENCE: During the inspection it was observed that staff understood residents needs. Examples of this included: • • • members of staff commenting that their training was “ good” and they “enjoyed” coming back to the home to put what they had learnt into practice, two visitors said that they felt that the home was “safe” and felt that the home met their relatives needs. staff in the dementia unit showed the inspector their latest “dementia mapping” report which measures the quality of interaction and “well being” for those residents. Staff saw this as a positive thing and said that they had put the reports recommendations into practice. Wade House DS0000037227.V275909.R01.S.doc Version 5.1 Page 9 Some situations were discussed that involved the deterioration of residents and the ability of the home to meet their needs. In these cases the home had sort advise, and ongoing input, from health and social care professionals and also involved relatives/representatives and the resident in all decisions. Wade House DS0000037227.V275909.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9. Residents’ will benefit from continued improvement to care planning, risk assessment and review. They can also expect the home to ensure that they can meet needs of residents whose mental or physical health has deteriorated, or make suitable referrals where they cannot. Whilst the home can evidence that its staff complete training and demonstrate good practice when handling and managing medication, this is undermined by a policy and procedure that does not reflect current good practice or guidance. This does not ensure that residents are fully protected from potential risk. EVIDENCE: The previous inspection required that where a risk assessment triggers an action to be implemented, or a decision made, must be clearly recorded, trackable and reviewed. Team leaders have started to implement new care plans that are to be reviewed by the residents key workers every month. Elements of this include: Personal Information District Nurse visits Visits and Events Wade House Skin assessment GP Information & Medical History Resident Contract Professional Support Leisure Record of Falls DS0000037227.V275909.R01.S.doc Version 5.1 Page 11 Life History Nutritional Intake Medication Review Night Personal Care Continence Personal Care These have clear instructions for staff to review and maintain the care plan. Care plans seen evidenced that where needs increased the home had introduced records to observe behaviour and worked with outside professionals to resolve concerns. In one case a resident had been individually observed and different techniques used to try and manage their behaviour. Records showed that the GP, relatives and other professionals had been involved. In another case the deteriorating health of a resident had been closely monitored alongside the District Nurse and GP. A Team Leader confirmed that care plans are reviewed with Key Workers at Supervision. We asked how changes are made between these meetings. They stated that a communication book is in place and any changes are made to the care plan and highlighted on the daily records. The home has a medication policy and procedure called “Instructions for Administration and Disposal of Medicines in County Council Residential Homes For Older People 2002”. This does not include up to date information including the National Minimum Standard for Medication, referencing instead to the Joint Inspection Unit which no longer exists. Details on the use of covert medication include reaching agreements with the resident and/or their relatives, however it does not require agreement from a GP. It was noted that in practice the home did seek agreement from GP, and had a detailed risk assessment. We fed back to the Team Leader that the date that the relatives agreed and signed the assessment should be dated. The Deputy Manager takes a lead responsibility for medication within the home and is supported by a Night Team Leader. They were available to discuss the process with the Inspector. Medication Administration Records (MAR), controlled drug and return records where all complete. Records were tracked from the residents recorded “refusal” on the MAR to the pharmacy returns logs. Storage was well organised with stock rotation also in place. Staff confirmed that they were not allowed to handle medication unless specifically trained to do so. Team Leaders are generally the only members of staff with this responsibility although those in “acting up” roles are also trained. The Team Leader had introduced an A-Z of Medication folder to explain what different medication is for. During the inspection six Team Leaders attended medication training, 3 of whom where attending for a refresher, with an outside professional. They also had concerns that the homes own policy and procedure hadn’t been updated, but felt the actual practice in the home was safe. The medication is audited and any issues are highlighted in “live supervisions”, giving staff immediate feedback if any discrepancies have been highlighted. Wade House DS0000037227.V275909.R01.S.doc Version 5.1 Page 12 The thermometer on the front of the drug fridge and an unsecured thermometer inside, did not display accurate readings. The Team Leader and Inspector agreed that this needed to be rectified and temperatures checked and added to the audit, on a regular basis. Wade House DS0000037227.V275909.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14, 15 Residents can expect the home to promote social interaction and one to one activities that have meaningful outcomes. EVIDENCE: Care plans do not all show the outcomes from residents partaking in activities. However new documentation for care plans is being undertaken that asks about residents’ interests, hobbies and community activities. Staff are then required to complete the date of the activity and the outcome for the resident. The Registered Manager said that activities are currently determined by individual choice and the time of year. Staff in Willow confirmed that they provided daily “meaningful” activity for the eight residents but this is also decided on a day to day basis depending on residents moods and choice. The home has a member of staff who organises activities for 1½ hours, three times a week. This can be one to one or part of a group. Residents said that they enjoyed the exercise classes, another adding they were looking forward to the next one “especially after such a lovely Christmas lunch”. The last Dementia Mapping report commented on the good and “fulfilling” activities, including cooking, that take place in Willow. Good interaction was observed between staff and a resident who was restless. Carers got a small Wade House DS0000037227.V275909.R01.S.doc Version 5.1 Page 14 group together and asked if they wanted to play cards. The resident then talked about the different games they knew and said they “wouldn’t mind learning a new one”. On the day of inspection residents were observed playing cards, making jigsaws and helping to take down low level Christmas decorations and cards. Residents, staff and visitors talked enthusiastically about the events over the Christmas period, which included visits from local organisations and carol singing. Staff said that they thought that residents especially enjoyed Christmas dinner because everyone in the home came to the downstairs dining room to eat together. As with previous visits and reports, residents continue to be able to have meals and drinks, in any area of the home they chose. A varied and well-presented five-week menu is in place and residents talked with, continue to be positive about the food at Wade House and feel they can ask for specific things if they want. A large communal dining room is available for those who wish to use it near the main entrance of the home. Smaller dining areas are used in the other two areas of the home. Nutritional screening, risk assessments, dietary requirements and weight charts are in place on care plans and the kitchen staff are aware if high calorie options are needed. During the inspection it was observed that a GP, Pharmacy Advisor, Hairdressers, friends and family had access to the building in order to visit residents. Wade House DS0000037227.V275909.R01.S.doc Version 5.1 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 the following standard(s): 18 Reorganisation and the introduction of new checks should ensure that residents are further protected. EVIDENCE: The previous inspection required that the home ensure that information and documents relating to staff working in the care home are obtained and available for inspection. This includes documentation that confirms identification. Team Leaders are in the process of organising all personnel files to ensure they meet with regulatory requirements. Two files were selected at random and where found to be complete. Wade House DS0000037227.V275909.R01.S.doc Version 5.1 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 the following standard(s): These Standards were not inspected during this visit. EVIDENCE: Not applicable. Wade House DS0000037227.V275909.R01.S.doc Version 5.1 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 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): 28, 29. Residents can expect Wade House to ensure that there is a well trained and competent staff team. EVIDENCE: At the last inspection 52 of staff had a recognised professional qualification in care, meeting the General Social Care Council Work Force Training Targets. Visitors to the home said that they thought the staff “know what they are doing” and raised no concerns, although they were not sure what training they should have. However this is detailed in the Service User Guide, which they said they had been given. The Registered Manager has kept the CSCI informed of ongoing recruitment developments. Although some positions are still needed they felt that now Team Leader posts are filled this had had a positive effect within the home. On the day of inspection the home was very busy with a hospital admission and training also taking place. It was also a Team Leader meeting day, which meant that all were on site. Their presence inevitably helped and residents commented about there being “a lot of people about”. They did not raise any concerns about the level of staffing, although a relative/visitor comment card did say that they had noticed that recruitment was taking place. As detailed in the section Complaints and Protection, personal files are being organised and the elements required included. A new checklist has been introduced for this purpose. Wade House DS0000037227.V275909.R01.S.doc Version 5.1 Page 18 Wade House DS0000037227.V275909.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 37, 38. Residents can to expect the home to place high importance on the quality of its service. Continued and ongoing efforts to improve the recording and review of information should benefit staff, residents and their representatives. EVIDENCE: Mrs. Curle has been the manager at Wade House since May 2003 and became the Registered Manager in November 2005. She has obtained NVQ4 for Training and Development, D32/33 assessors’ and Advanced Management of Care Services qualifications. In addition to this she is waiting for verification of work submitted for the Registered Managers Award and NVQ Level Four Combination Award. She has also attended courses in Dementia Care Mapping through Bradford University and is involved with using this skill in other County Council homes. The home keeps minutes of meetings which clearly show who is responsible for any actions. These also show that residents and staff are consulted and are Wade House DS0000037227.V275909.R01.S.doc Version 5.1 Page 20 able to discuss issues affecting the home. One staff member commented that they felt the home was supportive and had an “open culture” Others said that they would approach the Registered Manager if they had any concerns, although they usually talked to the Team Leader during Supervision. Records seen including, care plans, staff and medication records showed improvements in accuracy and in the majority of cases records had been completed. The Registered Manager and Team Leaders stated that this was ongoing work and would be monitored and audited regularly. The atmosphere in the home, although hectic, was positive. The Registered Manager stated that there is still some concerns about the future of the home. They had had staff meetings about the consultations by the local authority currently in progress, and are being kept informed about decisions made. The home does not handle money on behalf of residents. The Statement of Purpose and Service User Guide confirm this. Lockable cabinets are available in bedrooms for residents to keep valuables securely. We were able to walk round the whole home, which on the day of inspection was clean and tidy. All the residents’ bedroom doors have been replaced with fire doors. COSHH materials were stored in locked cabinets/storage areas. Water temperatures tested at random fell within the required limit. We talked with the person responsible for maintenance who confirmed that they completed regular checks on the water, heating and fire systems at the home. Wade House DS0000037227.V275909.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 3 3 Wade House DS0000037227.V275909.R01.S.doc Version 5.1 Page 22 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 OP9 Regulation 13(2) Requirement The medication policy and procedure must be updated and reflect nationally recognised good practice. The home must be able to evidence that medication, which requires refrigeration, is kept at the right temperature. Timescale for action 31/03/06 2 OP9 13(2) 31/03/06 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 OP1 Good Practice Recommendations The Statement of Purpose and Service User Guide should include details about how the home meets the needs of residents whose mental or physical health deteriorate. This should include any assessments, techniques, therapies and/or other professionals’ advice, the home can implement. The home should ensure that when an element of the care plan/risk assessment is given a date for review, it should be clear that that review has been completed and when the next one should be. DS0000037227.V275909.R01.S.doc Version 5.1 Page 23 2 OP7 Wade House 3 OP7OP8 4 5 OP7OP8 OP12 The home should ensure that when changes/significant information is entered onto the Team Leaders Communication Book for handover purposes, issues of confidentiality are adhered to. . Information needing to be added to a residents Care Plans should be available to all staff involved in their care immediately The home should ensure that it evidences the outcomes it achieves from residents activities and social interaction. Wade House DS0000037227.V275909.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Wade House DS0000037227.V275909.R01.S.doc Version 5.1 Page 25 - 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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