CARE HOMES FOR OLDER PEOPLE
Wall Hill Broad Street Leek Staffordshire ST13 5QA Lead Inspector
Wendy Grainger Key Unannounced Inspection 14 August 2006 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 Wall Hill DS0000005030.V306104.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. Wall Hill DS0000005030.V306104.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Wall Hill Address Broad Street Leek Staffordshire ST13 5QA 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) 01538 399807 Wall Hill Care Home Limited Mrs Susan Jane Briand Care Home 31 Category(ies) of Dementia (4), Mental disorder, excluding registration, with number learning disability or dementia (1), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (9), Old age, not falling within any other category (31), Physical disability (9), Physical disability over 65 years of age (9) Wall Hill DS0000005030.V306104.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 9 PD - 1 of whom may be minimum age 50 years on admission 1 MD minimum age 55 years on admission Date of last inspection Brief Description of the Service: Wall Hill is a care home that is registered for 31 older people, 9 of who may have needs associated with a physical disability, and 9 of whom may have mental health needs. The home is located close to the centre of Leek, which has a wide range of community facilities. Close to the home itself there is a large supermarket and there are also pubs and other amenities. There is good access to local transport, and the home also has its own minibus, a well used and popular facility. The home was opened in 1992 and consists of a 2 storey building that has undergone considerable refurbishment to meet the needs of the service users. There are 29 single bedrooms, and 26 of these have en-suite facilities. There is 1 double bedroom. The rooms are pleasantly decorated and furnished, and have been personalised by the service users to reflect their individual tastes and interests. A range of attractive communal sitting areas are provided at Wall Hill, with four lounge areas and a large and attractive dining room that opens onto the rear grounds. There are ample toilet and bathing facilities in addition to the en-suite bedrooms. The home is set in large grounds that are well maintained and easily accessible. From the information provided in the pre inspection questionnaire the current fees were £325-£384 at the time of this report. Wall Hill DS0000005030.V306104.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was completed on the 1st August 2006 with two of the providers one being one of the care managers for the home. Every assistance was given to the inspector during the time spent at the home by the providers, staff and residents. Records, documents and reports were inspected. A tour of the home was conducted. Staff and residents were part of the inspection and comments will be included in the report. The home was exceptional in its hygiene, well maintained with a rolling programme of refurbishment and decoration. At the time of this inspection there were thirty residents at the home What the service does well:
The residents at Wall Hill were provided with a high standard of hygiene, quality furnishings and fittings including carpets. Many of the residents and the staff on duty were spoken with; they expressed their satisfaction about the home, care, food and social opportunities, staff felt supported by the management. Six relatives comment cards were received at the Commission, three chose not to make additional comments but were very satisfied with all aspects of the home. Comments made additionally were “Wall Hill provides a friendly caring environment. The staff are genuinely concerned about the residents and there is always a homely atmosphere, food is fresh” “ I cannot praise the home highly enough. My friend always has a smile with something to look forward to his smile was not there before.” The home is spotlessly clean, warm welcoming what ever time of the day I call, staff are always helpful and willing to help”, “ my mother is very well looked after, the home is clean and never smells, the staff always have a cup of tea ready when we arrive “ The residents had completed six comment responses. Each one was very satisfied with the home and all the aspects of care and nourishment, support and social life provided additional comments include “first class” “I am very grateful for the arrangements regarding transport to the surgery” “management are always prepared to listen” “ experiences in other homes do not compare to Wall Hill I have been so happy here and feel that this is my final home”.
Wall Hill DS0000005030.V306104.R01.S.doc Version 5.2 Page 6 One professional questionnaire commented that “care staff look after clients well”. On going staff training ensures that the residents were living in an environment where they were supported by competent, experienced staff. What has improved since the last inspection? What they could do better:
While the risk assessments had moved forward they remained somewhat limited in their detail; the concept of risks needs to be explored further. Advice was given to the providers at feedback. There remains a requirement from the previous inspection to ensure that each of the staff had received fire drill training this includes the night staff and fire drill should be completed at appropriate times. The Statement of Purpose should include the new category (DE) Dementia Care and the philosophy of care for this resident group. To ensure that all the required information in Schedule 2 was current in the staff records. The decanting of medication is not acceptable. Medication should remain and be administered from the container/box it is dispensed in by the pharmacist. Wall Hill DS0000005030.V306104.R01.S.doc Version 5.2 Page 7 To comply with the regulations the providers should be confirming the assessment and agreement to meet the individuals heath and personal needs in writing. The format of the care plans remained uncomplicated; there was need to consider streamlining the folder to ensure that the information and support provided was active and up to date. It is important to the safety of the residents that all personal toiletries are either returned to their bedrooms or secured in a cupboard in the bathrooms/toilets. 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. Wall Hill DS0000005030.V306104.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 Wall Hill DS0000005030.V306104.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4, Quality in this outcome area was adequate. This judgement has been made using available evidence including the inspection of documents and speaking to the providers. No resident was admitted to the home without an assessment of their health and personal needs. Residents and or their representatives following an assessment were not informed that the placement was suitable. Information provided in respect of the facilities provided were clearly displayed and available. Wall Hill DS0000005030.V306104.R01.S.doc Version 5.2 Page 10 EVIDENCE: The Statement of Purpose was available in the entrance hall, the providers need to include the telephone number of the Commission in the event of a person making a complaint. Following discussions it was agreed that the providers would include the new registration for the care of people with dementia and the homes philosophy for this category. Pre assessments continued, and there had been the appropriate introductions to the home before admission. Following the pre admission assessment and agreement that the home could meet the person’s health and personal needs; the providers were required to inform the person or representative in writing. This was a requirement to meet the National Minimum Standards Regulations. Wall Hill DS0000005030.V306104.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement was made using available evidence including visual observations, reading care plans and discussions with the providers. Care plans, while uncomplicated would benefit from being streamlined to ensure they were up to date. Arrangements were in place for the continued health care from other professional agencies. The system for the administration of anti-biotics was not safe. The skills of the staff were observed and based on sound principles of care this was confirmed by the residents (with the exception of the administration of medicines). Wall Hill DS0000005030.V306104.R01.S.doc Version 5.2 Page 12 EVIDENCE: The care plan format was uncomplicated; they were a little confusing in respect of the present requirements of individuals based on current needs. The plans would benefit from streamlining and removing information which was out of date. From the three plans seen each one for a different dependency; there was no evidence of the needs of the person with dementia being recorded. The previous report identified the need for risk assessments, the documentation and risks recorded seen were limited in their content. This was discussed with the providers and advice given. The daily records were comprehensive and issues of concern were addressed. Arrangements were in place and observed on the day of the inspection for the continued health care of the residents. The inspector observed the lunchtime medication process undertaken by the senior care assistant, she demonstrated her understanding of the residents ability, speaking and explaining to each person prior to administration. The inspector had concerns in respect of decanting medication (anti-biotics) by the management from the container, it was dispensed into small identified envelops for the daily requirements. Dispensing medication is unacceptable. This report makes it a requirement to review the practice. From discussions with the staff and later discussed with the providers that more wide-ranging training on the safe handling of medicines should be provided. Self-medication was part of the providers’ commitment to ensure life skills were maintained. All precautions were in place for the safe keeping of medicines. During the inspection the staff were observed to interact with the residents, some of who were ready to go into the community. They ensured that they had all their needs. Staff were very pleasant and answered questions posed by the inspector. Staff assisted when necessary to facilitate individuals to enjoy their chosen life style. It was obvious that the staff created a very relaxed atmosphere, and that residents responded to this. Wall Hill DS0000005030.V306104.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14,15 Quality in this outcome was excellent. This judgement has been made using available information including speaking to the residents, staff and observations of the entertainment. The daily routines of the home were flexible and based on the interests of individuals. Wall Hill had a comprehensive wide-ranging diverse activity programme. Residents were offered a balanced varied diet based on their choice. Contact with families and friends was encouraged and maintained. EVIDENCE: A large number of the residents were spoken with. Each one had only complimentary comments about the home, managers, and all the staff including the housekeeping and catering. The home had an extensive social programme, which was evidenced by current photographs and discussions with the residents. One resident displayed jigsaws framed and hung in his bedroom. At the time of the inspection musical entertainment was provided by a ventriloquist/musician. It was pleasant to
Wall Hill DS0000005030.V306104.R01.S.doc Version 5.2 Page 14 hear during the inspection gentle piped music. Annually there is a fund raising event for charity. The home had its own personal transport used weekly for outings of, which residents told the inspector could be varied and all around the area. Resident’s maintained contact with relatives as was observed during the visit when one resident made the weekly visit to family. The home had an open visiting policy this was part of the information during the admission process. The residents were relaxed and shared their experiences of living at Wall Hill and bantered with the inspector. Residents spoken with were complimentary about the food served, this was observed when lunch was taken, when little was returned to the kitchen. The catering staff maintained daily contact with the residents seeking their choice of food. Temperatures were maintained, the cook took the daily temperature of food when prepared, it was agreed that she would record the results in the daily menu diary. Wall Hill DS0000005030.V306104.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement was made using available information including speaking with staff, resident and management. Staff were aware of the responsibility to protect residents from abuse. The complaints procedure was displayed in all the relevant documents. EVIDENCE: The Commission or providers had received no complaint. Questionnaires completed by the residents indicated that the providers would listen to any concerns. The information to make a complaint was displayed in the relevant documents. There was a recommendation that the telephone number of the Commission is recorded in these documents. Staff and records confirmed that they had received training in the protection of residents from any form of abuse. Wall Hill DS0000005030.V306104.R01.S.doc Version 5.2 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): 19,20,21,24,25,26 Quality in this outcome area is good. This judgement was made using available evidence including a tour of the home, speaking to residents. The standards throughout the home were exceptionally well maintained, with quality furnishings and fittings. Residents were encouraged to personalise their own bedrooms. There were some concerns as to the safety of the residents due to toiletries not being stored appropriately. Wall Hill DS0000005030.V306104.R01.S.doc Version 5.2 Page 17 EVIDENCE: Located on the periphery of the town of Leek, the home stands in well tended gardens. The providers had a positive on going programme for the upgrading and refurbishment of the entire home, this was evident during the tour of the home; fresh crisp bed linen was observed. Wide corridors and four lounges enable the residents to move freely around the home. Each area in the home was fitted with quality carpets. Bedrooms were personalised to suit each individual. There was evidence of interests displayed in certain bedrooms. The inspector pointed out to the provider during the tour of the home that toiletries should not be left unsecured in bathrooms and toilets they were a potential hazard to residents. Ideally they should be returned to individual’s bedrooms or secured in a cupboard in the bathrooms. This report makes this a requirement. Pointed out to the provider was the need to secure a ceiling fan in one of the toilets, where the rubber loop had perished The exceptionally high standards throughout the home were a credit to the housekeeping staff. Wall Hill DS0000005030.V306104.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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): 27,28,28,30 Quality in this outcome area is good. This judgement has been made using available evidence including speaking with residents, staff and from observing records. The staffing levels were adequate to meet the personal and physical needs of the residents. Recruitment of new staff were adequate there were some areas that required updating to include all the relevant details. EVIDENCE: The providers/managers were part of the staff team, the staffing levels for any one day would be three carers, plus manager, two housekeeping (AM) two catering. This would reduce by one catering and one housekeeper for the afternoon shift. The home had three night staff two of whom would be awake with one person on sleep in duty. Two new staff had been recruited since the previous inspection. From the information in the pre inspection questionnaire 50 of the staff had achieved NVQ in Care. Wall Hill DS0000005030.V306104.R01.S.doc Version 5.2 Page 19 Staff records following employment were made available. There were some areas that were required to be upgraded including photographs, copies of birth certificate, passport photo copy (if any) two written references should be requested and kept on file. These omissions were discussed with the providers and will be part of the requirements of the report. There was evidence of obligatory training undertaken by the staff. The staff spoken with also confirmed this. The matrix used to monitor and record staff training was not current and would benefit from updating. Wall Hill DS0000005030.V306104.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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 33 36 38 Quality in this outcome area is good. This judgement was made using available evidence including speaking with residents, staff and providers. The home is operated to the best interest of the residents. Records were secured, well maintained and available to staff when necessary. Staff were experienced and competent to provide the appropriate care. EVIDENCE: The home operates to ensure that the residents maintained their life style, by offering choice with an extensive social programme. The records maintained in respect of the required testing of the fire system protected residents. There was a previous requirement made that fire drills should be completed at different times to ensure all the staff were aware of the
Wall Hill DS0000005030.V306104.R01.S.doc Version 5.2 Page 21 procedure. This had not been completed and will be addressed. This requirement will be reflected in the report/requirement. The providers obtains feed back from the residents and their relatives it was recommended that these surveys should be extended to the stakeholders to have a more comprehensive analysis. Staff and the providers confirmed that regular supervision was planned, there was a need to record and maintain records, and ideally the staff member should sign and be given a copy of the supervision. Wall Hill DS0000005030.V306104.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 X 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 X 3 4 3 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 3 3 Wall Hill DS0000005030.V306104.R01.S.doc Version 5.2 Page 23 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 OP38 Regulation 23(4) Requirement Ensure that the timing of fire drills are varied so that all staff take part at least once every six months. Previous timescale of 30/09/05 not met Timescale for action 10/09/06 2 OP4 14 (d) 3 OP9 13 (2) 4 OP21 13 (4)(a) The registered person shall 10/09/06 confirm in writing to the resident or representative that the home can meet their needs following the annual assessment The registered person shall make 10/09/06 arrangement for the handling, safe administration of medicines at the home and in order to this more training of staff should be arranged. The registered person shall 10/09/06 ensure that all parts of the home to which residents have access are free from hazards to their safety, by removing the toiletries identified and securing the ceiling fan. Wall Hill DS0000005030.V306104.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP7 Good Practice Recommendations To include in the Statement of Purpose the new category of registration and the telephone number of the Commission For Social Care Inspection. To ensure that the care plans are current and up to date by streamlining the information on file. To review the risk assessments as discussed and ensure that each persons risk was identified with a plan of action both documents to be reviewed monthly. To record the temperatures of food served in the diary as agreed. To develop the quality surveys by including the stakeholders for the home To record the formal supervision session with the staff for training and development needs. To update the training matrix to ensure that records were current. To ensure that all the details in the staff records were current 3 4 5 6 7 OP15 OP33 OP36 OP30 OP30 Wall Hill DS0000005030.V306104.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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