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Inspection on 01/03/07 for Warberries Nursing Home

Also see our care home review for Warberries Nursing Home for more information

This inspection was carried out on 1st March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

The home has been expanded since the last inspection in May; visiting health and social care professionals and staff reported that this expansion impacted negatively on the standard of care being provided. owever this appears to be improving, more staff have been employed and residents say their needs are being met.

What the care home could do better:

Residents are not given individual copies of the statement of purpose or a guide to services in the home this poses a risk that residents may not be aware of all the services and facilities available to them. Although improving, the variable practice regarding the planning and delivery of care means that all services users cannot be sure that their health and personal care needs will be fully met. It has been recommended that residents care plans should set out in detail the action which needs to be taken by care staff to ensure that all aspects of their health, personal and social care are met. The plan should be drawn up and reviewed with the resident and/or their representative, recorded in a style accessible to them agreed and signed whenever capable. A record of complaints is kept. However, a visitor to the home said they had made a complaint to the home`s owner in January and there was no record of this. The poor recording of complaints poses a risk that complaints may not be dealt with and actions may not be taken to rectify problems. It was noted that there was only one call bell available in the lounge at the time of the visit. This poses a risk that a number of residents may be unable to summon assistance when needed. Height adjustable beds should be provided to residents who have been assessed as requiring them. Failure to do so poses a risk to both the service users and staff`s well being when care is being provided. The home should introduce a no smoking policy for staff and provide a smoke free environment for residents. There was a strong odour of cigarette smokeand some staff and visitors to the home have mentioned this poor practise takes place in this health care setting to the Commission. The homes recruitment practice does not fully protect residents from being placed at risk of harm or abuse. References are not always sought and police checks are not always performed before a person commences employment. This places residents at risk as people not suited to working in care may be employed. Formal management systems need to be introduced. Communication within the home could be improved and formalised which would increase staff morale and improve information shared. This would result in improving the care that resident`s received. The registered persons should introduce a quality assurance programme to identify how the home is doing in terms of meeting its aims and objectives residents` views should be part of this process.

CARE HOMES FOR OLDER PEOPLE Warberries Nursing Home Lower Warberry Road Torquay Devon TQ1 1QS Lead Inspector Fiona Cartlidge Unannounced Inspection 1st March 2007 09:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Warberries Nursing Home DS0000059901.V326238.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. Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Warberries Nursing Home Address Lower Warberry Road Torquay Devon TQ1 1QS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 294563 01803 292219 warberries@yahoo.co.uk Red Healthcare Ltd Miss Vasanta Marni Suddock Care Home 49 Category(ies) of Dementia - over 65 years of age (2), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (49), Physical disability over 65 years of age (49) Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for Dementia over 65 years (2), Learning Disability over 65 years (1) Old age not falling within any other category (49) and Physical disability over 65 years (49). Two service users who are under the age of 65 years may be accommodated. 31/05/06 Date of last inspection Brief Description of the Service: The Warberries is a large extended Victorian property, situated in a quiet residential area of Torquay. The property has sea views from some rooms and from 2 communal rooms. The Warberries is currently registered to provide nursing and or personal care to a maximum of 49 residents of either gender who are over the age of 65 years. There is a Registered nurse on duty at all times. Red Healthcare Ltd owns the home; a Registered Nurse Manager does the day-to-day management of the home. The accommodation is provided on 3 floors and is accessed by passenger lift, stair lift or stairs. Adapted toilets and bathing facilities are available for residents. The home has nursing equipment to meet the needs of residents who require nursing. Communal rooms comprise: A large lounge and dining room on the ground floor and a large conservatory with sea views and a small ‘quiet room’ A large entrance hall also provides seating and contains a pool table. Bedroom accommodation is offered in 41 single rooms, of which the majority have en-suite facilities, and 4 double rooms. Information about the home was found in the entrance hall, people can request a copy of the latest inspection reports from the administration office. Information given to the Commission by the provider indicates the current range of fees is from £450 to £516/week. Additional charges are made for chiropody, hairdressing, newspapers/magazines and personal toiletries. Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit took place over 5 hours 30 minutes and was unannounced. Two inspectors performed a partial tour of the home when some bedrooms and all communal areas were viewed. Four residents had their care case tracked. This means their records were examined in detail and two of these residents were spoken to in depth about the care and services they receive. Ten other residents were spoken with during the visit, as were 3 visitors/relatives, 4 members of staff the provider and manager. Personnel records of 4 members of staff and policies and procedures were also inspected. Feedback was also received from surveys returned by 13 members of staff and 2 relatives/visitors and 5 visiting health and social care professionals. What the service does well: Prospective residents have their needs assessed before admission, this means that when they are admitted the home accepts they can meet those needs. Residents spoken with confirmed they receive a good level of care. Records are maintained for all visits to the home by social or health care professionals, all residents are registered with a GP. Records provided evidence that as well as visits from General Practitioners, district and specialist nurses, chiropodists, physiotherapists and dentist’s visit. Records of outpatient appointments show that visits to community and hospital health resources are enabled. Staff were seen and heard knocking on doors before entering rooms and were carrying out personal tasks in private. Staff observed in conversation with residents were heard to be courteous and respectful. Residents told us they feel safe and listened to. Residents spoken with confirmed social activities are arranged, they spoke of bingo and a visiting singer who had attended the previous week. On the day of the inspection a number of residents were participating in an exercise class, the provider of this class confirmed exercise classes take place twice/week, and they also provide a massage service to residents. The people living in the home said they were happy with the visiting arrangements, visitors said they feel welcomed into the home visiting was seen to take place in the lounge and privately in residents own rooms. Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 6 Generally the environment is satisfactory, the décor and furnishings are homely. A passenger lift provides access to less mobile residents between floors. Visitors and residents spoken to at the time of the visit were complimentary about the staff and made positive comments such as- ‘the staff are very good, easy to talk to and any issue is dealt with promptly’, ‘the staff are kind and caring they do their best’. What has improved since the last inspection? What they could do better: Residents are not given individual copies of the statement of purpose or a guide to services in the home this poses a risk that residents may not be aware of all the services and facilities available to them. Although improving, the variable practice regarding the planning and delivery of care means that all services users cannot be sure that their health and personal care needs will be fully met. It has been recommended that residents care plans should set out in detail the action which needs to be taken by care staff to ensure that all aspects of their health, personal and social care are met. The plan should be drawn up and reviewed with the resident and/or their representative, recorded in a style accessible to them agreed and signed whenever capable. A record of complaints is kept. However, a visitor to the home said they had made a complaint to the home’s owner in January and there was no record of this. The poor recording of complaints poses a risk that complaints may not be dealt with and actions may not be taken to rectify problems. It was noted that there was only one call bell available in the lounge at the time of the visit. This poses a risk that a number of residents may be unable to summon assistance when needed. Height adjustable beds should be provided to residents who have been assessed as requiring them. Failure to do so poses a risk to both the service users and staff’s well being when care is being provided. The home should introduce a no smoking policy for staff and provide a smoke free environment for residents. There was a strong odour of cigarette smoke Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 7 and some staff and visitors to the home have mentioned this poor practise takes place in this health care setting to the Commission. The homes recruitment practice does not fully protect residents from being placed at risk of harm or abuse. References are not always sought and police checks are not always performed before a person commences employment. This places residents at risk as people not suited to working in care may be employed. Formal management systems need to be introduced. Communication within the home could be improved and formalised which would increase staff morale and improve information shared. This would result in improving the care that resident’s received. The registered persons should introduce a quality assurance programme to identify how the home is doing in terms of meeting its aims and objectives residents’ views should be part of this process. 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. Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are not aware of information that is available about this service. Prospective residents have their needs assessed before admission this means that when they are admitted the home accepts they can meet those needs. This home is not registered to provide intermediate care. EVIDENCE: The home has a statement of purpose this document sets out the aims and objectives of the home and provides information about the service. This booklet was available in the entrance of the home. Residents are not given individual copies of the statement of purpose or a guide to services in the Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 10 home. Residents spoken to were unaware of information about the home and the manager could not confirm that each resident is provided with a copy. An assessment of care needs of prospective service users takes place prior to admission to the home. Records seen included copies of assessments carried out through care management arrangements and hospital/community health care teams where applicable. The personal records of 4 residents were seen in detail and 2 of these residents were then spoken with about their experience of living at The Warberries. Documents seen provided evidence that the home uses a standard pre- admission assessment form. Assessments seen were sometimes not dated or signed. Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although improving, the variable practice regarding the planning and delivery of care means that all services users cannot be sure that their health and personal care needs will be fully met. Residents are largely protected by the homes policies and procedures for dealing with medicines. Residents are treated with respect and their right to privacy is upheld. EVIDENCE: Residents spoken with confirmed they receive a good level of care. Personal records held on behalf of 4 residents were examined; in all of those seen there were documented assessments which provided information about skin integrity, moving and handling, safety - including risk of falls, nutritional Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 12 screening and social needs. The information generates the plans of care, which provide the basis for the care to be delivered. They were found to be generic, pre printed and non-personalised. Some of the records seen were unclear and inconsistent and there was little evidence that residents or their representatives are involved in the planning or review processes. The plans provided a great deal of information about medical conditions/diseases, including a description of the effects of conditions but insufficient information about how staff should care for the individuals who lived with the conditions. Records are maintained for all visits to the home by social or health care professionals, all residents are registered with a GP. Records provided evidence that as well as visits from General Practitioners, district and specialist nurses, chiropodists, physiotherapists and dentist’s visit. Records of outpatient appointments show that visits to community and hospital health resources are enabled. The Commission received feedback in surveys and conversation from 5 social and health care professionals who visit the home, Comments included ‘ I have always found the manager and her staff caring and supportive of clients and their families, I never have any concerns when clients tell me they have chosen the Warberries’, ‘there have been concerns that clinical decisions are made at the nursing home which should be left to a doctor’, the home offers individualised treatment they are proactive in the care of the elderly’, ‘the place smells of smoke, the proprietor is rude and abrupt as are some of the nurses on the phone, I avoid the place as much as possible, I wouldn’t put my dog there’. The medication system is generally well managed; the inspector looked at storage and recording – controlled drug stock was checked against records and found to be correct The home uses a monitored dosage system, which is well organised and easily audited and administered from purpose built trolleys directly to the residents on a 1:1 basis. There were some gaps in the administration records of medicines not administered from the trolley e.g. lotions, creams and inhalations this poses a risk to residents as medication may not have been given or excessive doses may be given in error. Disposal of unused medication is safe, well recorded and removed by a licensed contractor. Staff were seen and heard knocking on doors before entering rooms and were carrying out personal tasks in private. Staff observed in conversation with residents were heard to be courteous and respectful. Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A range of activities takes place within the home but failure to advertise these may mean some residents do not have the opportunity to participate in stimulating and motivating activities. Residents are aware of menu choices and they receive a nutritious diet. Residents are able to maintain contact with family and friends; visitors are welcomed into the home. EVIDENCE: During the site visit, some residents were seen sitting in the lounge; in one part of the lounge a television was on, but none of the residents seemed to be aware of or interested in the programme. Other residents were seen spending time in their rooms, reading, listening to music, and watching television. Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 14 Residents spoken with confirmed social activities are arranged they spoke of bingo and a visiting singer who had attended the previous week. On the day of the inspection a number of residents were participating in an exercise class the provider of this class confirmed exercise classes take place twice/week, and they also provide a massage service to residents. Activities residents told us are advertised by word of mouth, with staff telling them what’s available. Staff were seen to spend some time in conversation with residents when able. The feedback about food was positive all of the residents spoken to said how good it was; A choice of menu is available and a record is kept of the food eaten by each of the residents. The people living in the home said they were happy with the visiting arrangements, visitors said they feel welcomed into the home visiting was seen to take place in the lounge and privately in residents own rooms. Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents feel safe and listened to. However formal processes need to be further developed so that the home’s procedures are available, understood and consistently applied. EVIDENCE: The complaints procedure was found situated in the entrance hall and in notices in areas of the home. Two people who had their care case tracked said they were aware of how to make a complaint and know who to speak to if they are not happy they said they would talk to ‘the manager or staff’. All confirmed they had nothing to complain about. Residents said they feel safe living in the home. A record of complaints is kept however a visitor to the home said they had made a complaint to the homes owner in January and their was no record of this in the complaints register and the complainant had received no formal response to their complaint. The policies and procedures seen, included information on adult protection and whistle blowing. Staff training records show that staff have recently received training on the protection of vulnerable adults. The Commission sent surveys to all members of staff, 13 were returned 12 of those who responded confirmed they are aware of adult protection procedures. Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally the environment is satisfactory the décor and furnishings are homely; there are areas of the home that would benefit from improvement. EVIDENCE: The home has doubled in size since the last inspection; previously a semi detached property the home now includes the next-door property making it a large detached building set within its own grounds. A partial tour of the home took place, not every bedroom was seen, but those that were looked homely and there was evidence that residents have been able to bring personal belongings with them in to the home. Those residents spoken Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 17 to about their private accommodation said they like the décor in their own rooms and have everything they need. The furniture, furnishings and equipment in the large lounge and dining rooms appeared to be in good order; variable height chairs and pressure relieving cushions were seen in use. However at the time of the visit there was a large leak from the ceiling in this lounge, we were told this was due to an overfilled bath in the room above. It was also noted that there was only one call bell available in the lounge at the time of the visit this poses a risk that a number of residents may be unable to summon assistance when needed. A Ground floor conservatory was seen to have a leak in the ceiling, tiles had been removed and staff confirmed it is awaiting repair. Entries made in the maintenance book also indicate there have been leaks in other ceilings in the home thought to be caused by a leaking roof. Some hallway carpet has started to fray; we saw however that these ends were well stuck down. A fire door on the mezzanine floor was seen to lack a fire-retarding strip, this staff confirmed had been identified during a recent fire risk assessment, and action was still required. One bathroom that can be accessed via 2 doors was found to have only one of its doors fitted with a lock and a shower/wet room was fitted with a lock but it doesn’t work. During a random inspection in November 2006 whilst case tracking a resident it was found that, despite the resident needing all their care provided for them whilst in bed, they were actually being cared for in a ‘divan’ type non adjustable bed, this poses a risk to both the service users and staff’s well being when care is being provided. To compound matters an over-lay low air loss mattress (pressure relieving) was in place on top of the divan mattress and both sides of the bed had bedrails attached – this did not provide any safety for the resident as the top of the mattress was almost in line with the rail. During this inspection visit another resident who was case tracked was found to require mechanical assistance and the help of 2 staff to rise and retire to bed they too were found to have a ‘divan’ type non adjustable bed in their room with an over-lay mattress on top of the divan mattress and both sides of the bed had bedrails attached – this did not provide any safety for the resident as the top of the mattress was almost in line with the rail. A Passenger lift provides access to less mobile residents between floors. The cleanliness in the kitchen was of a satisfactory standard and the laundry room was tidy. Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 18 Staff were seen to smoke cigarettes in the office that is situated close to the entrance and main hall of the home, there was a strong odour of cigarette smoke and some staff and visitors to the home have mentioned this poor practice takes place in this health care setting to the Commission. The rest of the environment was found to be largely odour free and hand wash facilities and disposable gloves were generally available through out the home. Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is showing some improvement. After expanding there were not always enough staff to meet the needs of residents this is no longer the case this should result in better outcomes for people using the service. The homes recruitment practise does not fully protect residents from being placed at risk of harm or abuse. EVIDENCE: The Commission sent surveys to all members of staff, 13 were returned. Two commented that they thought the shift hours were too long (13 hours for some). Three said they thought they needed more staff; one commented that they lacked support and time to meet the needs of residents in the way they would like to. Staff spoken to during the visit and in feedback on the surveys said there has been staffing difficulties since the expansion resulting in the staff struggling to meet basic needs. During a random inspection of the home in November 2006, the night duty rota confirmed only 2 staff were on duty plus one sleeping-in staff, and that the ‘sleeper’ goes to bed when residents have settled, usually about midnight. At the time of that inspection there were 35 service users at the home with Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 20 varying needs. A number of residents required assistance from 2 members of staff for their care, and it became apparent that if another resident or residents required attention at the same time this would not be possible. This and the use of a gate to restrain another resident indicated staff do not have the time to meet the service user’s needs appropriately. At the time of this inspection visit there were 39 residents in the home the duty rota states there are now 3 members of staff on night duty. On the day of inspection there were 8 care staff and a registered nurse on duty as well as the manager, domestic, catering and maintenance staff. We examined the personnel records held on behalf of 4 members of staff the records were incomplete and did not all contain 2 written references, evidence that Criminal Record Checks had been obtained or POVA 1st checks had been performed before their employment commenced. There were no records of 1:1 supervision or individual training needs analysis. Each file did contain a completed application form documentary evidence of induction training (Skills for care). There were indications that the members of staff had received some training in fire safety, Protection of vulnerable adults and swallowing and feeding and first aid. The records lacked sufficient detail to provide evidence that staff receive the recommended minimum of 3 paid days training/year. 10 care staff have obtained a National Vocational Qualification in care a further six are studying towards level 2 and one at level 3. Visitors and residents spoken to at the time of the visit were complimentary about the staff and made positive comments such as- ‘the staff are very good, easy to talk to and any issue is dealt with promptly’ ‘the staff are kind and caring they do their best’. Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 21 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): 31,33,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Communication within the home could be improved which would increase staff morale and improve information shared. This would result in improving the care that residents received. This home lacks a quality assurance process this means that residents cannot be sure that the home is meeting its aims and objectives. EVIDENCE: Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 22 The manager of the home is a 1st level registered Nurse who also holds a diploma in management. Records seen show recent training received has not included clinical updating although training has been received in fire training and employment matters. Key responsibilities are delegated to other staff. There are 2 administrators one is responsible for acting as appointee for 5 residents as well as resource management of the building and fabric of the home. The other administrator is responsible for managing staff resources and policies and procedures. Formal communication between these senior members of staff including the manager is not effective. Senior nursing staff are responsible for clinical care including planning and delivery. The job descriptions seen for senior members of staff did not reflect the expectations or boundaries of each expected role. The minutes of staff meetings were seen these showed an authoritarian approach to communication there was little evidence that staff are encouraged to provide feedback or be innovative or imaginative as part of their role or members of the team. The manager confirmed there have been no resident/representative meetings held, communication with residents and or their representatives she says is informal and is not documented. The home lacks formal internal quality assurance processes; The registered provider provided evidence of his visits to the home in accordance with regulation 26 of the care homes regulations these lacked detail and were not useful in assisting him to assess whether the objectives of the home are being met. The report of a random inspection performed in November 2006 had not been shared by the Provider with the Registered Manager the report had been sent to the providers address therefore actions required had not been suitably addressed this poses a risk to residents and a number of requirements which have been made are continually not being met. Throughout the inspection, as detailed throughout the report the manager and provider have failed to meet regulations and standards under the Care Standards Act 2000 potentially putting service users at risk and not protecting their health, welfare or safety, for example consistently not meeting requirements made in relation to provision of information to residents about the service, care planning, recruitment and maintenance practices. Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 23 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 2 17 X 18 3 2 X X X X 1 X 2 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X X X X 3 Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 24 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 OP1 Regulation 4,5&6 Requirement The registered person must ensure there is a written statement of purpose and service user guide, which is kept under review. A copy of the service users guide must be provided to each service user any revision must be notified to the service users and the Commission within 28 days. [Previous timescales NOT MET 1/9/06 and 01/12/06] Timescale for action 01/05/07 2. OP9 13(2) The registered person must 01/05/07 make arrangements for the recording, handling, safe keeping, safe administration and disposal of all medicines received into the care home. This relates to accurate recording of administration of non-oral medication including creams, lotions and inhalations. 3 OP24 16(2) The registered person must having regard to the needs of service users provide suitable bedding and equipment to meet DS0000059901.V326238.R01.S.doc 01/06/07 Warberries Nursing Home Version 5.2 Page 25 4 OP26 13(4)© 5 OP29 19 their needs. This relates to providing adjustable beds for those assessed as requiring them. (previous timescale not met 01/01/07) The registered person must ensure that unnecessary risks to the health of service users are identified and so far as possible eliminated. This relates to staff smoking in the home resulting in service users and visitors being submitted to passive smoking. The registered person must not employ a person to work at the care home unless he has obtained in respect of that person all of the information and documents specified in paragraphs 1 to 7 of Schedule 2 of the care home regulations. [Previous timescales not met 1/8/06 and 01/12/06] The registered provider must visit the home unannounced at least once a month and shall during the visit interview with their consent and in private such of the service users and their representatives and people working at the care home in order to form an opinion of the standard of care provided in the care home, inspect the premises, its record of events and complaints and prepare a written report on the conduct of the home. The registered provider shall supply a copy of the report to the Commission and the registered manager. [Previous timescales not met DS0000059901.V326238.R01.S.doc 01/05/07 01/05/07 6 OP33 26 01/05/07 Warberries Nursing Home Version 5.2 Page 26 01/08/06 & 01/12/06] RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Service users plans should set out in detail the action which needs to be taken by care staff to ensure that all aspects of their health, personal and social care are met. The plan should be drawn up and reviewed with the service user and/or their representative, recorded in a style accessible to them agreed and signed whenever capable. Up to date information about activities should be circulated to all service users in formats suited to their capacities. A record should be kept of ALL complaints made and include details of investigation and any action taken. Where a timescale has been set for compliance with any standard relating to the physical environment of the home a plan and programme for achieving compliance should be produced and followed and records kept. Residents should have the means of calling staff at any time – each resident should have a call bell available to them when they are in the communal areas of the home. To maintain the privacy and dignity of residents’ doors to bathrooms should have safe functioning locks. All staff should receive a minimum of 3 paid days training/year and have an individual training and development assessment and profile. 2. 3 4 OP12 OP16 OP19 5 6 7 OP19 OP19 OP30 Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 © 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 Warberries Nursing Home DS0000059901.V326238.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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