CARE HOMES FOR OLDER PEOPLE
Walmer House 6 Ash Hill Road Torquay Devon TQ1 3HZ Lead Inspector
James Rose Unannounced Inspection 17th March 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 Walmer House DS0000018447.V286426.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. Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Walmer House Address 6 Ash Hill Road Torquay Devon TQ1 3HZ 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) 01803 292734 01803 292734 keychangewalmer@aol.com Keychange Charity Mrs Sharon Elizabeth Hewitt Care Home 17 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (17) of places Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th August 2005 Brief Description of the Service: Walmer House is a large detached Victorian house which stands in its own grounds. The home provides 24-hour care for up to 17 persons who require care by reason of old age or dementia. Accommodation is provided in single rooms throughout, 14 bedrooms have on suite facilities available. A large comfortably furnished communal lounge is situated on the ground floor. Meals are taken in a dedicated dining room at small tables seating up to four persons. A vertical lift is provided and appropriate aids for persons with mobility issues. At the front of the home there is a large off road parking area, to the side and rear of the building there is a well-tended garden with extensive views of the surrounding area. Walmer House is run as a Christian charity by Keychange. The home is situated approximately half a mile from the town centre of Torquay. Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and was undertaken over four hours on 17th of March 2006. A tour of the communal areas of the home was undertaken and samples of the care records were examined. The way care was delivered was observed and five residents were consulted about life at Walmer House. The proposed registered manager assisted throughout the inspection. What the service does well: What has improved since the last inspection?
The residents at the home are always very positive about life at Walmer House and advised that they were well cared for and that they liked the environment provided. A substantial effort has been made by the proposed registered manager to complete the requirement of the last report. Assessments of residents’ needs and the care plans are almost complete and a renegotiated timescale has been agreed. Care staff now adhere to the policy and procedure in place for the correct administration of medication in the home at the time of this inspection. Staff supervisions are in place and the personnel files are being brought up to date. Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 Page 6 The home is now reporting events covered by Regulation 37 and progress has been made in the training needed by care personnel and a renegotiated timescale has been agreed for completion. Should any of the renegotiated timescales prove to be too demanding a target the proposed registered manager should contact the Commission without delay. What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 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 Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 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): 3 and 6 Some new assessments are in place and the remainder are being produced, these are comprehensive and cover all the needs of residents. EVIDENCE: A sample of the new care assessments being undertaken by the home were examined, these were comprehensive and covered the areas of health, personal and social needs. An extension of one month has been agreed with the proposed registered manager for this process to be completed. Standard 6 refers to a service not provided at Walmer House. Walmer House DS0000018447.V286426.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, 9 and 10 A comprehensive care plan is being produced for each resident. Service users are able to self medicate where appropriate and residents are protected by the homes medication administration procedures. Residents felt they were respected at all times and their privacy was maintained in the home. EVIDENCE: New care planning has been undertaken in the home for all residents. This process is not yet complete and a renegotiated timescale has been agreed with the proposed registered manager for this to be achieved. The new care plans are constructed from a detailed assessment of an individual resident’s needs, they are comprehensive and cover the areas of health, personal and social needs. The recordings undertaken by the home of the administration of medication were examined and were found to be clear, complete and up to date, this system clearly protects residents. Any resident that wished to self medicate is able to do so subject to an appropriate risk assessment approach to ensure they have the capacity and are safe.
Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 Page 11 Five residents were consulted during the inspection; they were all very happy at the home and advised that they were well looked after. They said they were treated with respect and that carers ensured that their privacy was maintained. One resident said “ I’m very happy here and the manager is always ready to listen” another remarked “I enjoy my shower and can always get help when I need it”. Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Residents’ enjoyed the lifestyle at Walmer House and felt they had enough interests. They were able to have visitors at anytime and could come and go as they wished. Carers gave residents assistance and space to make decisions and residents felt in control of their lives. Service users have wholesome and balanced meals in the home. EVIDENCE: Five residents were consulted during the inspection process at Walmer House, they advised that they enjoyed the lifestyle and could not suggest any additions to the interests catered for in the home. Two residents made very positive comments about the morning religious services they take part in. The home has an unrestricted visiting policy and procedure and residents confirmed that they could receive friends and family at anytime. Some residents were seen to have difficulty in decision-making and carers were observed giving them time and help to reach their own view about what they wanted. Five residents were consulted during the inspection process and they all advised that they felt in charge of their life at the home.
Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 Page 13 All the residents consulted advised that they liked the meals provided at the home and added that they like the new cook. Residents were consulted about what foods they would like to consume and choice was always available to them. One resident with a smile said, “ The food is fine and I don’t have to get it” another advised “ I always enjoy my meal and like eating it in the dining room with the others”. The home has a dedicated comfortable dining room where meals are served to small tables that seat up to four persons, the residents consulted like this approach. Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents were confident that if they raised an issue this would be resolved for them and they were protected from all forms of abuse. EVIDENCE: All the residents consulted were confident that if they raised an issue with the proposed registered manager this would be taken seriously and quickly resolved for them. At the time of the last inspection some residents were not aware of the home’s policy and procedure concerning complaints and a copy has now been provide in the hall of the home. This is also being followed up by individual packs of information that is being put together by the proposed manager and given to each resident. The home has a clear policy and procedure that covers all types of abuse and what action a carer should take if this was discovered. Staff have been trained in its use and a refresher course is currently being arranged to ensure residents are safe. Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Residents at Walmer House live in a safe, well-maintained environment that is clean, pleasant and hygienic. EVIDENCE: Walmer House provides a comfortable, safe environment for the people who live there. The home has a running maintenance programme and redecoration is undertaken as required. A complete tour of the communal areas of the home was undertaken and high standards of hygiene were evident throughout. No malodour was found and residents said the home was always very well kept. Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 Page 16 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 There are always sufficient numbers of staff on duty to meet residents’ needs but the home does not have a stable well-trained staff group available any deficits are made up by the use of agency personnel. EVIDENCE: The home continues to have deficits in the care team. Currently the care team at the home consist of one full time carers and one part time plus the proposed registered manager, this is during the day. The home’s staff covers all weeknights with some support needed by agency carers at weekends. The proposed registered manager is currently addressing the issue raised in the last report concerning carers not following the policies and procedures. She is ensuring that all personnel are aware of what the policies and procedures are and is advising that if these are not followed disciplinary action will be taken. The proposed registered manager is now spending most of her time focused on meeting the requirements in place and the administration of the home and not in providing hands on care. Residents consulted during the inspection advised that they were well cared for at the home and felt that they could rely on the staff team for assistance at anytime. The manager is addressing the deficits found in the personnel files at the last inspection.
Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 Page 17 Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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 and 38 The proposed manager has made substantial progress to correct the deficits found at the last inspection to the administration of the home. The home is run in the best interests of the residents. Health and safety issues are seen as important and are given priority. EVIDENCE: Five residents were consulted during the inspection process and they agreed that they felt the home provide a good service and that it was run in their best interests. Management issues that were found at the last inspection are being addressed as a matter of priority. Health and safety issues are given priority by the management of the home and risk assessments have been put in place. The fire precautions undertaken
Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 Page 19 by the home were examined and found to be appropriate and up to date, the electrical appliances were checked and the installation of electricity at the home had a current certificate at the time of the inspection. The vertical lift and other aids used throughout the home were appropriately serviced which ensured that residents were safe. Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 3 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 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 3 Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 Page 21 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 OP3 Regulation 14 Requirement The registered provider must ensure that an assessment is undertaken of all the needs of a prospective resident. (Previous timescale of 16/03/06 not met) The registered provider must ensure that the service user’s health, personal and social care needs are set out in an individual plan of care. (Previous timescale of 30/03/06 would not be met) The registered provider must ensure that quality assurance systems are in place to check that carers are following the policies and procedures in the home. (Previous timescale of 02/03/06 not met) The registered provider must ensure that the documents called for in Schedule 2 are in place for each person working at the care home. (Previous timescale of 02/03/06 not met) The registered provider must ensure that staff are trained and competent to do their jobs. (Previous timescale of 02/03/06 not met)
DS0000018447.V286426.R01.S.doc Timescale for action 16/04/06 2 OP7 15 30/04/06 3 OP33 13 02/04/06 4 OP29 19 02/04/06 8 OP30 18 02/05/06 Walmer House Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Walmer House DS0000018447.V286426.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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