Inspection on 12/09/05 for Walton Heath Manor

This inspection was carried out on 12th September 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Walton Heath Manor 29/08/07

Walton Heath Manor 16/06/06

Walton Heath Manor 16/05/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Walton Heath Manor Hurst Drive Walton-on-the-hill, Surrey, KT20 7QT Lead Inspector Pat Collins Announced Monday 12 September 2005, 9:00 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 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. Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Walton Heath Manor Address Walton Heath Manor, Hurst Drive, Walton-on-the-hill, Surrey, KT20 7QT 01737 814010 01737 819903 whmanor@btinternet.com Hamilton House Medical Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) To be confirmed Care Home (CRH) 43 Category(ies) of OP Old age, 43 registration, with number PD(E) Physical dis - over 65, 3 of places Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. For a programme to be instituted for fitting radiator covers to non low temperature surface type radiators, with priority given to areas of highest risk to service users. Completion of the programme must be by 30th September 2005. Date of last inspection 16 May 2005 Brief Description of the Service: Walton Heath Manor is registered for the provision of personal care for 43 older people. The furnishings, fittings and décor of the home are to an exceptionally high standard. Bedroom accommodation is mostly single rooms arranged on three floors, accessible by two passenger lifts. All bedrooms have either full en suite bathrooms or en suite w.c. and wash basin. Suitable aids and specialist communal bathing facilities are available.The home has a number of communal areas including a private licensed lounge-bar and library and elegant dining room. The chefs prepare nutritious meals ensuring dietary needs and food preferences are accommodated. There is a large balcony at the rear of the building. Some bedrooms have personal balconies and terraces overlooking the large landscaped garden. This includes a sunken garden, water feature and ornamental fountain. The home is set in large grounds in a peaceful private road and has car-parking facilities to the front of the premises.The care philosophy and service purpose promotes and supports individual independence for as long as possible. Facilities include a hairdressing salon. The activities programme offers a range of social and leisure opportunities including occupational therapy and arrangements are made for religious observances to be met. People living at Walton Heath Manor have access to transport facilities in the homes minibus which is used for various excursions. Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this inspection. It commenced at 09.00hrs and concluded at 18.45 hrs. The inspection was announced meaning staff and residents were notified in advance of it taking place and a written notice was displayed prominently with details of the inspection date and time. This was the home’s second inspection for the year 2005/2006. The inspection process included a review of progress in meeting the requirements of the last inspection, which took place in May 2005. There was opportunity for separate discussions with the Responsible Individual for the registered organisation also the deputy manager, clinical care supervisor and senior care assistant. The inspector also spoke with one of the home’s two chefs, a group of care assistants and individually with seven residents and two visitors. A partial tour of the premises took place and observation made of interaction between staff and residents. The inspector also observed practice in response to an accident, specifically a fall by a resident and arrangements for the transfer of this individual to the accident and emergency department of a local hospital. Additionally the readmission and reassessment of needs of a resident following a stay in hospital; also discharge arrangements for another resident to a nursing home. Observations included examination of systems and practices for planning menus, food preparation and the presentation of meals. An organised activity taking place was indirectly observed. Medication practices were examined and various records, policies and procedures. Throughout this reports service users are referred to as residents. This is term preferred by management and used in the statement of purpose. Individual residents also stated a preference for this term. The inspector would like to thank the residents, Responsible Individual and the staff team at Walton Heath Manor for their courtesy and hospitality throughout the day of the inspection. What the service does well: Residents expressed feelings of empowerment through the home’s management and day – to -day operation. They described having freedom of choice in how they lived their lives within individual capabilities. A high quality of care was demonstrated. The care team overall demonstrated awareness of the needs of residents. The home had a mainly stable workforce Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 6 and staff demonstrated clarity of their respective roles and responsibilities. Without exception residents spoke highly of the kindness and helpfulness of the staff team. A resident asked to describe what in particular she feels was particularly good about life at the home, having described all aspects of provision in positive terms, stated simply “the warmth “. She attributed this to the attitude and approach of the whole staff team. A safe and secure, quality environment was provided with adequate arrangements for ensuring a high standard of maintenance, cleanliness and hygiene. A high standard of catering was evident affording residents a wide choice of food and ensuring nutritious, well prepared and nicely presented food, meeting dietary needs. Residents’ comments about meals indicated an overall high degree of satisfaction with meals. The therapeutic value of social stimulation was evidently recognised in the operation of the home. Links with residents’ friends and families were well established. What has improved since the last inspection? The resignation and departure of the registered manager since the last inspection had inevitably resulted in a sense of loss. It had also caused, for individual staff and residents, anxiety about change. Interim management arrangements appeared to support staff and residents through this transitional period. Management and some staff however acknowledged and discussed various difficulties and challenges encountered whilst trying to ensure continuity of services, routines and practices in these circumstances. Feedback from the residents who spoke with the inspector, with the exception of one resident, did not raise any undue concerns regarding the home’s current management. One resident referred to a general decline in standards, which was not evident on the day of the inspection. Significant work had been undertaken for development and improvement of care documentation, including various assessments and care plans. Also further development of the home’s policies and procedures. A review of residents needs had identified individual residents whose needs had changed; the dependency of some individual’s had increased to a level beyond the boundaries of the home’s registration. Arrangements for these individuals to be suitably assessed and discharged to alternative, more suitable placements had been made. Systems for care plan evaluations had been reviewed and improved to ensure dependency levels were in future adequately monitored and appropriate and timely action taken in response to changing needs. Record keeping systems had improved for inspection of Disclosures obtained for staff issued by the Criminal Records Bureau. Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 7 Pre-admission assessment procedures had been also reviewed and improvement made to ensure placements were compatible with the home’s stated purpose. Work was in progress for producing a new brochure and incorporated a review of the home’s admission criteria. A staff supervision structure was in place. Formal supervision sessions for care staff were being gradually implemented. A fundamental review of staff training had been carried out since the last inspection and a training plan was being developed. It was proposed to implement this within the budget for 2005/6. The aim was to standardise training opportunities across the companies group of homes and improve the induction and foundation training programme at Walton Heath Manor. The new programme will offer staff incentives aimed to motivate participation in the NVQ certificated training programme. A review of communication systems had taken place and regular management meetings were planned and general staff meetings. A programme for fitting radiator covers and fitting valves to control hot water temperatures was nearing completion. This had substantially improved the safety of the environment and enabled compliance with national minimum standards. What they could do better: Observations confirmed the need for further review and improvement to record formats relating to the admission assessment tool and transfer / discharge record. Systems for reviewing residents’ needs should be developed in due course to clarify with residents’ their satisfaction with routines that directly effect their day-to-day lives. An example of this is the timing of serving breakfasts in bedrooms and whether their wishes in this respect had changed since admission. For care plans to be further reviewed to ensure all needs were fully established, documented and addressed. Also for care documentation to be in further detail. The home’s whistle blowing procedures required review to ensure compatibility with local multi-agency and the home’s own adult protection procedures. Requirement was made for further applications to be made for Criminal Record Bureau Disclosures for some care staff who had Standard level Disclosures instead of Enhanced level. These Disclosures were obtained some time ago prior to the recent change of ownership. Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 8 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. Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 9 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 Standards Statutory Requirements Identified During the Inspection Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 10 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 standard(s) 1, 3 and 4 The home was overall found to be effectively operating in respect of these standards. The inspector was impressed by the availability and quality of information about the home; also confident that prospective residents, with support if necessary from representatives, could make an informed choice regarding the home’s suitability. Assessment procedures and processes had improved to ensure needs were assessed and reviewed. EVIDENCE: The Statement of Purpose and Service Users Guide, which included the latest inspection report and complaint procedure, were accessible to residents’ in home’s reception area. This information had been professionally produced. Since the last inspection the home’s assessment tools and procedures had been reviewed and improved. Areas of discussion with management included suggestions for further development of the assessment tool format. It would be useful if this contained details of any special equipment required to ensure these were available on admission and needs could be met. Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 11 The inspector was informed of recent reviews of residents’ dependency and needs to ensure these were being appropriately met in this setting. Over time needs had increased and it was established some residents’ needs would be more appropriately met by a nursing home. It was noted that some transfers to nursing homes had taken place prior to the inspection. Observations included assessment and discharge procedures for a resident in the process of transferring to a nursing home. These appeared satisfactory. In a discussion between the inspector and relative of this individual it was noted that this matter had been managed with sensitivity though inevitably the move had generated feelings of sadness and loss. General feedback from a General Practitioner in a comment card confirmed medical opinion that management was taking appropriate decisions when the home could no longer manage the health and care needs of residents. The discharge back to the home from hospital of another service user on the day of the inspection was appropriately managed. The deputy manager had assessed this individual’s needs whilst in hospital and arrangements were made to reassess this person’s needs again that day. He informed the inspector of his immense relief to be back home and expressed trust and confidence in the staff team to ensure his needs were met. Management had identified the need for additional equipment, which was being ordered to meet this individual’s longer-term needs. Also arrangements were planned for this individual to be referred for advice from palliative care specialists. The inspector was informed of a current review of the home’s palliative care policy and admission criteria. Also of the home’s brochure. Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 12 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 standard(s) 7, 8, 9 and 10 Evidence gathered from this inspection demonstrated that mostly these standards were effectively met. Some aspects for further development was discussed relating to risk assessments, care planning and review and documentation in care notes. Recommendation was made regarding the storage and recording of a Controlled Drug. The inspection outcomes gave confidence that individual needs and wishes of residents were recognised and met. EVIDENCE: It was positive to observe the general improvement in risk assessments relevant to the individual health and welfare of residents’ since the last inspection. Also the revision and substantial improvement in care plans formats. The hard work of the management team in this area of work was acknowledged. The recently appointed senior care assistant had been delegated this responsibility with support and guidance from the clinical care consultant and input from the deputy manager. Recognition was given to the contribution of the recently appointed administrator by the management team for developing new formats for risk assessments and care plans. Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 13 Areas of discussion with the management team and care staff included the need to develop record keeping practices for documentation of significant information in care notes. Staff’s individual responsibility for this could enhance the day-to-day management of the home, providing increased continuity of care and an aide – memoir for management to ensure needs were met. The personal files of residents’ sampled by the inspector contained a completed medical history record which was built on after admission. This provided a comprehensive medical assessment of needs. Mostly significant medical information was addressed in care plans. An omission to undertake a risk assessment specific to an individual’s medical condition and for this to be addressed in this individual’s care plan was highlighted to management. Residents were all registered with a General Practitioner and had access to primary and specialist health care services based on individual needs. A comment card returned to the Commission from a General Practitioner confirmed satisfaction with communication between the home and the medical practice. It was considered that the home worked in partnership with the medical practice and satisfaction was expressed with the overall care of residents. The General Practitioner stated that staff demonstrated a clear understanding of the care and health needs of residents. Observation made of the small sample of care plans reviewed confirmed mostly specialist advice from General Practitioner’s was documented in care notes and reflected in care plans. Observations confirmed one occasion where the care plan had not been updated to reflect recent medical advice. There was a strategy for the prevention of pressure sores. Feedback from a resident and a visitor that suggested a possible delay in obtaining medical advice for a medical condition, was not verified by the information available to the inspector. Arrangements were available for monthly visits by a chiropodist inclusive in fee charges. Medication storage, recording and practices were satisfactory and in compliance with relevant standards and guidance. The management team had discussed medication procedures at the time of their recent meeting. The meeting minutes confirmed the availability of copies of The Royal Pharmaceutical Society Medication Guidelines and Royal Nursing and Midwifery Council’s procedures held in addition to the home’s medication policy. Self-administration of medication was operating for some residents underpinned by risk assessments. In reviewing the management of Controlled Drugs prescribed for residents it was recommended that ALL Controlled Drugs, including Temazapam be stored in the Controlled Drugs cupboard and recorded in the Controlled Drugs register. Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 14 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 standard(s) 12, 14 and 15 Overall the home meets these assessed standards. Implementation of a system for care reviews would however enhance opportunities for residents to influence changes to their daily routines that will further enable them to exercise control over their lives. The standard of catering was high and met dietary needs and individual preferences. It was demonstrated that residents were encouraged and supported to be as independent and lead as fulfilling lives as they are able. EVIDENCE: There was stated to be no change to the activity programme since the last inspection. This was observed to be planned to provide opportunities for appropriate stimulation and for socialising. A care assistant had lead responsibility for coordinating and delivering a twice-weekly activities programme. This care assistant was observed engaging a group of residents in a gentle exercise session to music, at the time of the inspection. This session was well attended and feedback from individual residents demonstrated it was very much enjoyed and of benefit to their wellbeing. There was a range of activities available which included an in –house club for games of scrabble, bridge and dominoes and a gardening club. A mobile library, communion services, pastoral visits and visits to church were all Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 15 facilitated. Social events included an annual garden party, monthly shopping trips and theatre outings. Transport was provided enabling access to community activities including the village pageant and open days at gardens. Hairdressing facilities were available in the home and fortnightly hairdressing sessions were inclusive in the fee charges. A selection of newspapers and periodicals were provided daily in the lounge. Feedback from the residents who contributed to the inspection suggested residents were enabled by staff to exercise choice and control over their own lives. Feedback from one resident indicated the need for further consultation with this individual to establish whether a change in the time of serving breakfast in her room each morning was warranted. Systems were in place for establishing residents’ wishes in this matter but it was not evident that a formal process existed for review. Contract catering arrangements were in place. There were two chefs though at the time of the inspection one chef was on leave. The Environmental Health Department had carried out an inspection of the kitchen earlier this year under the Food Safety Act 1990 and the two recommendations arising had been met. A fly screen for the kitchen door was in place and provision made of additional tabards for care staff’s use when serving food. Since the last inspection nutritional screening had been implemented on admission and was subject to regular review. Observations confirmed provision of well balanced, nutritious meals served with the option of a glass of wine with lunch or supper. Systems were in place for residents to contribute to menu planning and a wide choice of food was available at each meal. Breakfasts were served on trays in bedrooms and once a week a cooked breakfast was available in the dining room. The elegant dining room afforded a spacious setting and meals and dining tables were presented to a high standard. The menu of the day was displayed in large print outside the entrance to the dining room. Feedback from those residents consulted by the inspector suggested overall satisfaction with the home’s catering standards, acknowledging the difficulties in pleasing everyone all of the time. Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 16 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 standard(s) 16 and 18 Complaint procedures and systems were accessible and ensured complaints were responded to efficiently and effectively. Whilst overall recruitment procedures safeguarded service users from abuse observations confirmed further attention to CRB practices for care staff. EVIDENCE: Robust staff recruitment procedures were evident however some Disclosures for care staff from the Criminal Records Bureau (CRB) had not been carried out at Enhanced level. Since the last inspection a record had been implemented for staff CRB Disclosures in compliance with statutory requirements. The home’s internal adult protection procedure was observed to be compatible with local multi-agency procedures of which the latest version was available on the premises. A review of the whistle blowing procedure was necessary to ensure this was also in accordance with the adult protection procedure. There was evidence of past adult protection training for some staff. The deputy manager and senior care assistant was booked to attend an adult protection training session organised by Surrey County Council. The organisation’s training plan shortly to be implemented in this home will ensure outstanding adult protection training is delivered. The complaint procedure was accessible to residents and their representatives and visitors. Since the last inspection there had been two complaints, both investigated within the home’s complaint procedures and the outcomes appropriately recorded. Feedback to the inspector from individual staff and a Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 17 resident indicated that a number of residents were expressing dissatisfaction with the management of the home since the resignation and departure of the home manager in June. This was not evident from the home’s records however or from information received from the majority of residents who engaged in conversations with the inspector. Information from a resident suggesting a general decline in standards was drawn to the attention of management for their consideration and review in relation to the home’s monitoring arrangements. Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 18 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 standard(s) 19, 22, 25 and 26 The facilities, size, design and layout of Walton Heath Manor were suitable for the home’s stated purpose and matched the philosophy of care. The environment was overall safe and well maintained and the elegant furnishings and fittings and high standard of cleanliness and hygiene ensured provision of a quality care environment. EVIDENCE: Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 19 The home was situated in large, secluded, well - maintained grounds and was spacious with tasteful, comfortable furnishings. The décor was to an exceptional standard and the home well maintained throughout. Provision included suitable equipment for meeting the assessed needs of service users. The environment was clean and hygienic and since the last inspection the domestic supervisor vacancy had been filled. A review of cleaning schedules was reported to have taken place and domestic staff were now responsible for the maintenance of the fresh flowers delivered weekly for the dining room and communal areas. A programme for fitting radiator covers and thermostatic valves for ensuring delivery of hot water at a safe temperature was nearing completion. Where these were not yet fitted risk assessments had been carried out to ensure residents’ safety. Discussions with the Responsible Individual and the management team confirmed a fundamental review taking place of the home’s admission criteria. The home’s purpose currently is for care provision for ambulant, active older people. Whilst it was evident that all residents’ were ambulant a the time of the inspection it was strongly recommended for the home to have one hoist for use in emergencies; also occasions of sudden loss of mobility due to physical illness. At the time of the inspection the deputy manager confirmed availability of one pressure relieving air mattress on the premises and a number of mattress overlays. She confirmed authorisation to purchase an adjustable height bed with integral airflow mattress for meeting the needs of a resident recently discharged from hospital. Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 The staff compliment ensured residents needs were met by the staffing levels. The domestic establishment had been recently reviewed and agreement secured to appointing an additional domestic. Current recruitment procedures and practices were robust in terms of ensuring adequate vetting of prospective staff. There was evidence of staff induction and training and acknowledgement of the need for improvement to the training programme. A training plan for 2005/6 was in place with agreed objectives for staff training needs to be fully met. EVIDENCE: The staff team was well established and staff turnover was low. Since the last inspection the home manager’s resignation had impacted on staff morale. Other tensions within the team were known to the Responsible Individual and being addressed. Discussions between the inspector and a group of staff confirmed areas of concern that they had had been communicated openly to the Responsible Individual who had increased the frequency of his visits to the home. Staff spoke very positively regarding the support and guidance from the recently appointed part – time clinical care consultant who they expressed confidence in. It was stated that she was introducing changes in a positive and constructive manner. Also since the last inspection a care assistant had been promoted to the vacant post of senior care assistant with delegated responsibilities for care planning, monthly care plan evaluations and reviews, risk assessments, compiling the Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 21 duty rota for night staff and ordering medication. The group of staff interviewed spoke highly of the competencies of the senior care assistant and her support and guidance to the team. The Responsible Individual confirmed details of the organisation’s staff training and development plan imminently due to be ‘rolled out’. This will ensure a competent workforce and compliance with statutory requirements and give recognition to and try to meet employees training aspirations. The induction programme had been revised and was stated to be directed towards new employees. At the time of the induction of the most recently appointed bank care assistant the workbooks for this induction had not been obtained and the former induction format used. The new induction and training programme was stated to be designed for provision of a direct pathway towards NVQ certificated training. Foundation training booklets were planned to be issued to each member of staff in due course. There was noted to be links with local training providers and access to Learning Skills Council funding. The Responsible Individual was awaiting the appointment of a new home manager to be involved in implementing the new training programme. Discussions with a group of staff established positive comments from a care assistant who was assured by the commitment of the Responsible Individual to a future pay reviews that she understood would link performance and training to pay scales. There was nine staff excluding registered nurses with NVQ Level 2 or above. This included the senior care assistant who had attained an NVQ Level 2 qualification and aspired to obtaining NVQ Level 3 in due course. The deputy manager advised of her intention to study for the Registered Managers Award NVQ Level 4 in due course. Observations confirmed staff to be clear of their roles and responsibilities. Positive feedback was received from all residents who spoke with the inspector about the kindness and cheerfulness of all staff. Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 22 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36, 37 and 38 Interim management arrangements ensured that the home was being effectively managed and various support mechanisms for the team were in place. Staff were appropriately supervised and a formal staff supervision system was being gradually implemented. Record keeping, though overall satisfactory, could be further developed, particularly care notes. Safe working practices were evident. EVIDENCE: The resignation and departure of the registered manager in June had resulted in a review of support arrangements for senior staff until a new home manager was recruited. These included input from a part – time clinical care consultant who had extensive relevant knowledge and experience and worked flexibly and supportively with staff on day and night duty. She had been working along side the deputy manager and senior care assistant, reviewing and improving Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 23 procedures including admission and assessment procedures, risk assessments and care plans. Also ensuring as far as practicable requirements from the last inspection were met. A review of communication systems had been undertaken and plans had been made for regular management and staff meetings, which had commenced. The deputy manager and senior care assistant were evidently having to assume a high workload and though coping they acknowledged this was at times challenging. The deputy manager had increased her hours to manage the workload. Also discussed was specific difficulties and conflict within the team that she was trying to manage. The senior care assistant acknowledged also personal development needs specific to her level of management experience. She considered herself well supported however by systems and arrangements in place. The need to ensure priority given to formal supervision sessions for the senior care assistant was discussed with management. Supervision sessions for other staff was in the process of being rolled out which was a positive development. Recruitment processes for replacing the matron/manager were at an advanced stage. These demonstrated due diligence to ensure appointment of a competent manager who is committed to the service ethos and values and able to take forward the service objectives. Statutory records were organised and overall satisfactorily maintained. Comment has been made in the relevant sections of this report where further development of records was warranted. It was noted that the format had been revised for notification of incidents to the Commission. Systems, risk assessments, standards of maintenance and staff training overall promoted the health, safety and welfare of residents. The programme for fitting radiator covers and hot water valves was nearing completion. On completion it was agreed this would be confirmed in writing to the Commission. A safe bathing policy had been implemented since the last inspection and bath thermometers were used. Plans were noted for provision of an outside smoking area for staff to reduce health risks to staff using the staff room. Since the last inspection the matron/managers from within the organisation’s small group of homes had met with senior staff at Walton Heath Manor. This created opportunity for sharing information and best practice and offered a support network for the deputy manager and senior care assistant since the departure of the home manager. Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 24 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 4 COMPLAINTS AND PROTECTION 4 x x x 3 x 2 4 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x x x x 3 3 3 Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 25 Yes 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 7, 8, 37 Regulation 12(1)(a), 13(4)(c), 15(20(b) Requirement To ensure risk assessments are undertaken in response to health related risks and these are addressed in care plans. Also for care plans to be updated as necessary to reflect changes in medical advice. Systems for reviewing care plans should incorporate routines that directly effect residents care in consultation with residents to establish whether any changes are necessary, for example, frequency and times of baths and time of serving breakfasts bedrooms. For care staff to have Enhanced Level CRB Disclosures. For care staff to receive all core training including adult protection training. For completion of the programme for fitting radiator covers and on completion for notification to be made to the Commission. For completion of the programme for fitting valves to control the temperature of hot water to hot water outlets used by residents. Timescale for action 12/11/05 2. 3. 4. 18, 27 18, 28, 30 38 19(a) 13(6), 18(10(a) (c)(i) 12(1)(a), 13(4)(a) (c), 23(1)(b) (2)(p) 12(1)(a), 13(4)(a) (c), 23(1)(a) 12/11/05 12/12/05 30/09/05 5. 38 12/12/05 Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 26 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 3, 4 9 Good Practice Recommendations For further development of the admission assessment tool format to include details of any special equipment or aids needed for meeting residents needs. For All Controlled Drugs including Temazapam to be stored in the Controlled Drugs cupboard. Also that the reciept, administration and disposal of Temazapam is recorded in the Controlled Drugs register. For revision of the homes whistle blowing procedure. For the homes equipment to include provision of at least one hoist. 3. 4. 18, 37 22 Walton Heath Manor H09 H58 s63264 Walton Heath Manor v230482 120905 stage4.doc Version 1.40 Page 27 Commission for Social Care Inspection The Wharf, Abbey Mill Business Park, Eashing, Surrey, GU7 2QN 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. 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