CARE HOMES FOR OLDER PEOPLE
Wantsum Lodge 32 St Mildreds Road Ramsgate Kent CT11 0EF Lead Inspector
Christine Grafton Unannounced Inspection 30th April 2008 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 Wantsum Lodge DS0000023619.V361120.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. Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Wantsum Lodge Address 32 St Mildreds Road Ramsgate Kent CT11 0EF 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) 01843 582666 01843 852 317 Choicecare 2000 Ltd Post Vacant Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 41. Date of last inspection 20th April 2007 Brief Description of the Service: Wantsum Lodge provides residential care for up to 41 older people. It is a detached three storey premises, with a lift access to each floor. The home offers mainly single bedrooms, with all, except two, having an ensuite toilet facility. All bedrooms have a wash hand basin and a call bell system. There are three double bedrooms, two of which are used as singles. There is a choice of communal areas. The home is situated within walking distance of local shops, post office and church. All other community facilities are accessible in the nearby town centre, including public transport links. Parking is on-street. The home’s service users’ guide gives information about the service and a copy is kept in each of the bedrooms. The most recent CSCI report is available on request from the home. The fees for support from the home are set during the assessment period and are very individual to the needs of the service user. The average fee levels, as a guide at this time, are between £320:63 and £605:00 per week. Additional charges are made for: taxis, hairdressing, chiropody, newspapers and personal toiletries. Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes.
This report takes account of information received since the last inspection, including a visit to the home. An unannounced visit took place on 30th April 2008 between 09:30 hours and 18:00 hours. The visit included talking to the acting manager, staff, residents, visitors and observing the home routines and staff practices. Some records were looked at and we looked round the home. Information sent to us by the acting manager prior to the visit, in the form of the home’s annual quality assurance assessment, has been used and information from the previous inspection referred to. There has been a change in the management of the home since the last inspection. The new manager has the title of ‘acting manager’ until the probationary period has ended, when he indicated he would apply for registration, after which he will be known as manager. Shortly after the acting manager took up his post there was a safeguarding adults alert raised, which was investigated by social services care management and the alert was closed. This report shows that the home has acted positively to address issues raised and is making improvements for the benefit of all residents. At the time of the visit there were 23 residents living at the home. The atmosphere in the home was welcoming and relaxed. What the service does well:
Wantsum Lodge provides a very comfortable, homely environment for all of the residents and has the adaptations and equipment to suit their individual and collective needs. Residents expressed that they are well cared for and comfortable in the home. They confirmed that staff are always available to help them when needed and are very kind and caring. One resident said, “Staff were especially kind when I first came in”. Another said, “They’ll do anything for you”. A visiting relative said, “They’re marvellous here”. Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 6 A staff member said how much they enjoy working at the home and all staff were seen to have developed good relationships with the residents and visitors to the home. Residents appreciate the daily contact they have with the acting manager, one resident said he “is very good” and went on to say that they know they can talk to the manager at any time and they are confident if they have a problem, he will sort it out. Residents enjoy their mealtimes, which are relaxed and unhurried. The dining room provides a congenial setting and every resident spoken to on this occasion said that the food is very nice and they always have a choice. Those wishing to eat in their bedrooms are supported to do so. One staff member said, “The food is brilliant here.” Catering staff know residents’ food likes and dislikes and make sure that alternatives are provided if anyone does not like either of the two main meal choices. Staff work well together and there is a good team spirit. All staff work in a way that shows respect for residents’ dignity. Care staff have a good understanding of residents’ needs and spend time talking with them and listening to them. Housekeeping staff take a great pride in their work and keep the home clean and fresh smelling, which makes for a homely environment. All toiletry items are attractively arranged in bedroom ensuites, or on shelves over washbasins, demonstrating respect for residents’ dignity. What has improved since the last inspection? What they could do better:
This home has demonstrated that it has some strengths and there are some good aspects to the service it provides. It now needs to continue, develop and
Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 7 sustain the improvements started, so that residents’ health, safety and best interests are fully promoted and protected. The new acting manager has already established good working relationships with residents, staff and visitors. He is making progress in bringing about some improvements, but recognises that more changes in practices are still necessary to ensure residents’ welfare. Most of the areas of weakness identified at this inspection have already been recognised and the acting manager has started work to address them. These include: The home’s statement of purpose and service users’ guide are to be revised to make sure that people have up to date information. The acting manager has given assurance that the new assessment and care plan documentation will be fully completed. This will then provide more information about each person, to make sure that their health care needs are identified and met, with actions specified to make sure that any risks are reduced. Staff are completing daily records for each resident, but more information is still needed to provide a full and clear picture for each day. This is important to protect residents, by showing how care is given and helps to make sure that things do not get overlooked. Some of the less able residents would benefit from being given more opportunities for activities to stimulate them and prevent boredom. The acting manager has identified a need for a designated activities person and it is recommended that this be put into place. A key worker system is to be developed and a more ‘person centred’ approach is being introduced. Each resident will then have a member of staff they will know has a prime responsibility for making sure they are looked after in all respects. The acting manager is also going to pursue training for staff to support residents with visual loss to ensure they continue to be as independent as possible. The acting manager is going to make sure that the bath hot water supply is checked to see if the taps are thermostatically controlled with cut off valves to reduce the risk of scalding. This would ensure that residents are kept as safe as possible. The new ‘wet room’ has no form of heating and residents might become cold while they are showering. The acting manager said he would look into this. It is recommended that a sluicing facility be provided for the cleaning of commode pans. This should be to the specification of the report from the Health Protection Agency specialist nurse. It is also recommended that a separate hand washbasin be provided in the laundry to reduce safety risks for staff and help prevent the risk of spread of infection.
Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 8 Staff files need auditing to make sure they contain all the necessary information. This is something that the law requires to show that staff have been properly vetted to protect the residents living in the home. The acting manager indicated that this would be done by 31st May 2008 Induction training for new staff and supervision for all staff is to be formalised to make sure that they have the relevant training and support from management and senior staff. This will help ensure that residents can have confidence that the staff are suitable to care for them. The home’s quality monitoring processes are to be strengthened and developed to gain the views of everyone with an interest in the home. This can then be used to ensure they influence any future changes made. There are good systems in place to safeguard residents’ personal monies. The acting manager is going to make sure that residents can have access to their own money at all times. Staff have attended a number of training courses within the past year. However the management must make sure that courses related to health and safety, for example, moving and handling training, are regularly updated so that safe working practices are promoted and residents’ safety is protected. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People considering moving into the home are given some information about the service to help them decide if the home is right for them. They have an assessment that is being developed so that it will tell staff enough about them and the support they will need upon moving in. It is not the general policy of the home to admit people for specialist intermediate care, so standard 6 was judged as not applicable at this inspection visit. EVIDENCE: The statement of purpose and service users’ guide reflect what the service has to offer and describe the day-to-day life at the home. The contents of both
Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 11 documents need reviewing and updating to reflect the changes that have occurred during the past year, in the management of the home, and to the building, with the provision of nine extra bedrooms. This will ensure that people have up to date information, so they can make a fully informed choice. A copy of the service users’ guide is kept in each bedroom. This provides most of the information that residents need to know about the home, including the complaints procedure. This does not currently have the telephone numbers for people to contact the home’s management, social services care management, or the commission, and these are to be added. The pre-admission documentation used to assess two new residents, admitted since the last inspection, was looked at as part of the case tracking. Since the last inspection, a new, in-depth assessment format has recently been developed. If this is fully completed it will provide the information necessary to make a decision about whether the home can meet the person’s needs. Documentation for the new residents included the pre-admission assessment completed by the acting manager, a hospital transfer form and the care management assessments. This combined information has started to form a picture of the person’s needs and provides the basis for the care plan. The new format covers social interests, hobbies, religious and cultural needs. The completed assessments provide an indication of the person’s likes, dislikes and interests. Although many of the sections of the new documentation had not been completed, the information taken together from the different sources, is enough to decide that the home will be able to look after the person. The senior carers are now becoming more involved in completing the home’s new assessment documentation following admission, after which the care plans are to be developed. A resident spoke about their admission process in a positive way, saying that their relative had visited lots of homes beforehand, but when they saw this home they knew it was the best. The resident said that they feel they have made a good choice, as they have everything they want at the home and all their needs are met. The resident said, “Staff were especially kind when I first came in”. Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Currently, residents cannot be confident that all their needs will be identified and risks minimised, because care plans do not provide staff with all the information needed to make sure that their health and personal care needs are met. They can be confident that the home’s procedures and practices for managing their medication will protect them and their dignity will be respected. EVIDENCE: At the time of this visit the acting manager was in the process of transferring information from residents’ care plans onto a new format. Of the four care plan files looked at, one had been fully completed in the new format, one had been started and the other two were in the old style. The new format, once
Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 13 completed will look at all the aspects of support and care needed by the residents. The care plans being used when the acting manager took up his post, five months ago, did not fully inform staff about the care that should be provided. Where risks were evident in the assessment documentation, the care plans did not always include a risk assessment, or identify the action needed to reduce risks. Care plans were not always updated to reflect the changing needs of the residents. As a result of a safeguarding adults referral raised in December 2007, the social services care management investigation showed that the home’s record keeping did not evidence whether all of the residents’ health care needs were being monitored and met. One care plan seen at this visit had not been reviewed and updated to reflect that the person needs a wheelchair now to get around, as was evident from meeting the person and talking to staff about their needs. The care plan dated November 2007 stated that the person walks independently, which is no longer accurate. A moving and handling assessment had not been completed and there was no risk assessment in place to address the risk of falls identified in the care management assessment. The daily records show that the person had fallen and sustained an injury on one occasion, but there was no evidence of any follow up action taken to reduce the risk of this happening again. This places the person at risk of harm if the staff are not provided with the written guidance about how to move and transfer them safely and if the reasons for the fall are not investigated. A care plan completed in the new format covers all aspects of daily living including: personal hygiene, skin integrity, nutrition, continence, mobility and moving and handling. It also shows some consideration of equality and diversity, but this needs to be further developed, as visual impairment and religious needs had not been properly followed up. It does, however, provide a reasonable overview of the person’s needs with some care instructions specified. The acting manager intends adding goal and action plans for each individual need identified. A care plan is currently being developed for a person with diabetes who has insulin medication. There is not yet a plan in place to show how the diabetes is being monitored and a risk assessment has not yet been completed to give staff the information on how to identify the complications of diabetes and what to do if these occur. Discussions with the resident and staff indicated that the staff have the knowledge and skills to meet the person’s needs. A medication round was observed during the visit. Medication was dispensed safely to residents and all medication administered was signed for. The senior
Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 14 carer demonstrated good knowledge of the various drugs in use and of insulin administration and diabetes. The current medication storage room has been recognised as not suitable and the acting manager has plans to move the medications to another, larger room. This is necessary as the current medication room has an unpleasant smell that has been noted at previous inspections. However, the medication cupboards in this room were clean and well ordered. The medication administration sheets had been properly signed and were up to date. The controlled drugs (CD’s) and CD register were checked and were correct. The acting manager has plans to introduce a key working system. Staff said that they are enjoying becoming more involved in completing the care plans. A staff member showed a good understanding of all of the residents’ needs, but was also looking forward to working in a more person centred way, when the new care plans are fully operational. Staff were observed assisting the residents in a caring and supportive manner, treating them with respect and understanding. A resident confirmed that staff show respect for privacy and dignity when assisting with personal care. The person also expressed that staff always respond to the call bell if they need assistance at night. Personal toiletry items are arranged in every bedroom in a way that demonstrates respect for dignity. Hairbrushes, combs, toothbrushes and denture pots were all clean and nicely laid out. All residents were well groomed and nicely dressed, wearing individual clothing. The hairdresser was at the home and one lady expressed how she values this weekly service, saying that it helps to make her feel good about herself. A relative said that the staff are very kind, they respect dignity and the care is good. She went on to say, “They’re marvellous here”. Another relative spoke about how the service has improved since the acting manager has been in post. Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Most residents benefit from being able to lead the lives they choose. Residents have some opportunities to take part in activities to suit their needs. However, the less able residents would benefit if more activities opportunities could be provided to stimulate them and prevent boredom. Residents can be confident that contacts with their families and friends will be encouraged and supported. They benefit from the relaxed mealtimes and enjoy their food and the choices available to them. EVIDENCE: A number of residents were spoken to and all expressed that they are content living at the home and that it suits their needs. They confirmed they have the choice to spend their daily lives as they want and staff said that residents’ daily routines are flexible. Care plans do not currently contain much information about residents’ interests, hobbies or past lives, but this is being rectified.
Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 16 Some activities are provided, such as, a monthly visit from a musical entertainer and a weekly activity session. Some residents pursue their own interests, such as reading books, newspapers, doing crosswords, watching television, socialising with each other and their visitors. Some residents are taken out by relatives and staff sometimes take residents out individually to the nearby shops. Residents use the garden in fine weather. This meets the needs of those residents who are able to make their own choices, but some residents, whose mental capacity is becoming impaired, were seen sitting in their armchairs with nothing to do. They receive some stimulation from the carers who were seen talking to them, but they would benefit if more organised activities were provided to stimulate them and prevent boredom. Two staff spoken to felt that residents’ quality of life could be improved if more activities were provided. They said they have enough time to meet residents’ care needs, but felt that a designated activities person would be an asset to the home. The acting manager has also identified this need in the annual quality assurance assessment (AQAA). A resident’s religious needs are not being met, for example, the manager stated he has been unable to access a Roman Catholic minister to visit them. A person centred care plan could identify this as a need to be met and look at other ways, for example, a staff member could be allocated to take the person to church on Sundays if that is their wish, which is not currently happening. A registered blind person has nothing in place to ensure their interests are maintained so that they can continue to be as independent as possible. Training for staff on supporting residents with sight loss, to provide an individualised approach, was recommended at the last inspection and is still outstanding. The acting manager said he would follow both these things up. Residents said they have lots of visitors to the home. Two visiting relatives were made welcome and commented that the staff are always very friendly and offer them refreshments. Residents spoken to expressed that the food is good. This was reiterated by two staff spoken to and one said, “The food is brilliant here.” There is a choice of two options at lunch and tea times and a wide choice at breakfast time. Meals are served in congenial surroundings in the dining room, or residents can have their meals in their rooms if they wish. Each resident has a copy of the menu plan in their bedroom. The cook knows residents’ likes and dislikes. Two meal times were observed and the food was seen to be well presented and served in a sensitive way. The AQAA indicates that a new menu is in place. Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their complaints will be listened to and acted on. Residents are adequately protected by the home’s procedures and practices to safeguard them from abuse. EVIDENCE: Residents spoken to indicated that they would talk to staff if they had any concerns. They expressed their satisfaction with the home, saying that all the staff are approachable. They know that they can speak to the acting manager about anything and that he will listen to them. They expressed their confidence that any concerns would be quickly dealt with. A copy of the home’s complaints procedure is included in the service users’ guide, which is available in all bedrooms. The acting manager indicated he will be revising this, to include details of how to contact the commission and social services care management, as well as contact telephone numbers for the owning company that people can use if they wish. Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 18 Any concerns raised by residents or their representatives are recorded. The acting manager indicated that he had not received any complaints about the home since he took up his post in November 2007. However, the commission has received three complaints since the last inspection, one of which was investigated by the home and the other two were the subject of a safeguarding vulnerable adults investigation, undertaken by social services care management. This happened shortly after the acting manager started work at the home. The providers have acted to address the issues raised and the improvements that have been made since then have had a positive impact on the outcomes for residents. This is evidenced throughout this report, by observations, records seen and discussions with residents, staff and the acting manager. However, the home needs to continue the improvements started and sustain better record keeping in respect of care planning and residents’ daily records to make sure that residents are properly safeguarded from the risk of neglect. The acting manager has developed good working relationships with everyone in the home, including, staff, residents, relatives and other visitors. There are still areas that need further development, but overall, residents have benefited so far and staff have stated that they enjoy working at the home. The staff training matrix indicates that six staff received training on safeguarding adults in February 2008 and a further two staff had done this previously. Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 & 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a comfortable, homely environment that suits their individual and collective needs. They can be assured that the recently improved practices introduced to maintain hygiene and prevent the spread of infection within the home will protect them from the risk of harm. EVIDENCE: Since the last inspection, the home has been extended to include nine extra bedrooms with ensuite toilet facilities. The new wing has been completed to a high standard, with spacious rooms, new furniture, carpets, curtains and attractive bed linen. Other areas are also attractive and homely. Bedrooms vary in size, most are spacious and all are well furnished, nicely decorated and
Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 20 individualised with personal possessions. The manager stated that eight sets of new wardrobes, drawer units and bedside cabinets, plus four new beds have been ordered. Lounges and dining areas are spacious and comfortably furnished. The home is well maintained and equipped with various aids, such as handrails in corridors, toilet aids, bathing aids, mobile hoist, stand-aid and lift. It was clear that the ongoing redecoration and refurbishment programme, required at the last inspection, is well under way. Bathrooms are fitted with aids and adaptations to meet residents’ needs. There is a choice of two different types of bath, two are fitted with a bath hoist and there is one Parker bath. All bathrooms are clean, with fully tiled walls and non-slip washable flooring. Bathrooms have fixed dispensers for liquid soap, paper towels, the dispensing of gloves, plastic aprons and bags for soiled items. Clinical waste bins are foot operated to reduce the risk of infection. A new ‘wet room’ has been created with walk-in shower. This will provide more choice for residents, but it has no form of heating. This needs to be addressed to ensure that residents do not become cold while they are showering. The hot water temperature was hand tested in one bathroom and felt so hot that it was hard to keep a hand under the running water. The acting manager stated that staff check the bath water temperature before they put a resident in the bath and there are bath thermometers in each bathroom, with temperature records kept. The acting manager was not sure whether the bath taps are thermostatically controlled with cut off valves to reduce the risk of scalding and indicated he would follow this up. Radiators have either been guarded, or are of a low surface temperature type, to reduce the risk of burns. All areas of the home were clean and fresh and there were no unpleasant odours. The Environmental Health Officer has recently inspected the kitchen and the acting manager reported that his recommendations have been completed and a cleaning schedule is in place. At the last inspection, a requirement was made for the laundry flooring to be made impermeable, which has been completed. A specialist nurse from the Health Protection Agency visited the home in February, following the adult protection investigation. The acting manager has introduced some of the changes recommended. There is no sluicing facility for the cleaning of commode pans and the specialist nurse identified that the method used posed safety risks for staff and a risk of infection. It is recommended that a proper sluice facility be provided to the specification of the specialist nurse’s report. It is also recommended that a separate hand washbasin be provided in the laundry. Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can be confident that there will be enough staff on duty that have the necessary skills to meet their needs. Recruitment policies and procedures need to be consistently followed to ensure that residents are fully protected. EVIDENCE: At the time of the visit, there were four care staff on duty, plus two cleaners, one laundry assistant and two catering staff, with the acting manager working in a supernumerary capacity. Rotas indicate four carers each morning and either three, or four, in the afternoons. Current night staffing levels consist of either two, or three staff on duty, with the aim for three every night. Discussions with the acting manager, residents and staff indicate that these numbers are adequate for the twenty-three current residents. There is only one room in the new wing currently occupied, but when resident numbers increase, the acting manager has recognised that more staff will be needed. He has already recruited one new day carer and one new night carer and is waiting for their criminal records bureau (CRB) checks before
Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 22 determining the start dates. It was discussed that the layout of the building over three floors and the spread of the new wing, will need to be taken into account when planning future staffing levels, as well as the dependency needs of residents. A staff-training matrix has been drawn up and shows where mandatory health and safety courses have been completed, as well as specialist courses in various different aspects of caring for older people. This shows that most staff have completed the mandatory courses, although some refreshers are due. Seven staff have achieved their National Vocational Qualification (NVQ) in care level 2, two have started working towards their level 2 and five have achieved their level 3. Catering and housekeeping staff are also working towards the relevant NVQ for their roles. Six care staff have recently started a three-month distance learning infection control course and two domestics and the laundry assistant have already completed this training. The acting manager stated there are more courses planned, with dates booked for dementia, challenging behaviour, dying and bereavement and Mental Capacity Act training. Four staff files were looked at and contained variable amounts of information. The files were disorganised, with loose papers, out of order, making it difficult to find the information. They contain application forms, with some interview records, basic induction records and some training certificates. There were some missing elements, for example, no photo identification in some, two files had only one reference and one had none, with one file having no evidence of the CRB or protection of vulnerable adults (POVA) register checks. The acting manager is aware that the files need reorganising and auditing to make sure they contain all the necessary information. As there is no administrative support at the home, this has not been started yet. It was a requirement at the last inspection for staff files to contain all the documentation specified in the regulations. It will be a requirement from this inspection for this to be completed by 31st May 2008. The acting manager stated that the Skills for Care Induction workbook has been introduced and a copy was seen that a new carer has started to complete. Copies of previous rotas indicated that during their induction, the new staff member was on duty as an extra person. The acting manager has not yet implemented a formal supervision process, but he indicated that he would set up a plan to do this for all care staff at two monthly intervals in future. Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 23 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 & 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recent improvements in the way the home has been managed is benefiting residents, so that their health and safety is being better protected and their best interests are promoted. EVIDENCE: There has been no registered manager at this home for approximately eighteen months. At the last inspection, a year ago, there was an acting manager in post who has since left. The new acting manager has relevant experience of working in a managerial capacity in a home for older people and has been in post five months. He has established good working relationships
Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 24 with residents, staff and visitors, and is making progress in bringing about the improvements identified in the adult protection investigation. Residents spoke about making their views known informally on a day-to-day basis, by talking to staff and the acting manager. They expressed their confidence that the acting manager would make sure that their views influence any changes made in the home. Staff said that communication in the home is good, for example they have regular handover periods between shifts and the acting manager makes sure that they are kept updated each day about anything they should know. Quality monitoring systems include regular monthly visits by a representative of the owning organisation who prepares a written report on the conduct of the home. A selection of questionnaires are kept in the entrance hall and relatives are encouraged to complete them. The acting manager has recognised that this needs to be formalised and plans to send questionnaires out to doctors, other health care professionals and visitors to the home, such as the monthly entertainer, the hairdresser and chiropodist. The results will then be summarised and published in the service users’ guide. The home’s annual quality assurance assessment (AQAA) provided very basic information. More supporting information would have been useful in most areas to illustrate what the service has done in the last year and how it is planning to improve. It is recognised that the acting manager did not have all the information to hand about the past year. However, the area manager might have been able to contribute in this respect. The acting manager now understands the importance of the AQAA as a tool to bring about improvement and indicated that during the forthcoming year he will endeavour to set the document up and start to complete it as improvements are made. Where the home handles residents’ monies, a safe system has been introduced to protect their interests. Records of expenditure and balance are kept. A sample was checked and was well recorded and had been audited by the area manager. Residents can access their money when the acting manager is on duty. It was discussed that residents might want to access it when he is off duty, so a system needs to be established to enable this. The tour of the building showed that appropriate health and safety practices are carried out. Some things have been referred to under the environment section that the acting manager has indicated would be followed up. Bedroom doors, and other doors in communal areas that need to be kept open, are fitted with automatic closures, to keep residents safe in the event of a fire. The staff files seen contained some certificates for training courses attended, including first aid, fire safety, food hygiene and moving and handling. Some of these need to be updated to ensure that safe working practices are promoted, for example, moving and handling training.
Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 25 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 2 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 3 3 3 x 3 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 x 3 2 2 2 Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 26 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 OP29 Regulation 19 Requirement That staff files contain all the information specified in schedule 2, regulation 19. Previous requirement made 20/04/07 and timescale of 30/06/07 not met. Timescale for action 31/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations To make sure that the new assessment and care plan documentation is fully completed for each resident and regularly reviewed. That all residents are provided with opportunities to take part in activities to suit their individual needs. To consider providing a designated ‘activities person’ to coordinate and implement a variety of different activities. 2 OP12 Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 27 3 OP30 To access appropriate information, environmental assessment and training regarding supporting service users with sight loss. (Outstanding recommendation from the last inspection of 20/04/08). That the bath hot water supply is checked to see if the taps are thermostatically controlled with cut off valves to reduce the risk of scalding. That the new ‘wet room’ is fitted with some form of heating to prevent residents from becoming cold while they are showering. That a sluicing facility be provided for the cleaning of commode pans to the specification of the report from the Health Protection Agency specialist nurse. That a separate hand washbasin be provided in the laundry to reduce safety risks for staff and help prevent the risk of spread of infection. 4 OP25 5 OP25 6 OP26 7 8 OP35 OP37 To make sure that residents can have access to their own money at all times. To make sure that more information is recorded in residents’ daily records to provide a full and clear picture for each day, in accordance with Sch.3 Reg. 17(a)(a) and to inform the care plan. Wantsum Lodge DS0000023619.V361120.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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