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Inspection on 10/05/07 for Warberries Nursing Home

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

This inspection was carried out on 10th May 2007.

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

There are, organised social activities; details were displayed on the notice board. And included in the `service user guide`. Exercise and activity classes are held twice a week and bingo is played weekly. In addition external entertainers on a regular basis supply musical entertainment and this was well received by a number of residents at the time of one of our visits. Residents said they enjoy the food at the home, the chef and some residents spoken to confirmed alternatives are provided if people do not want the set dish of the day. A resident`s daughter said: "My mother enjoys all the meals provided for her". The dining room is attractively laid; some choose to eat in their own accommodation. 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.Most of the residents were complimentary about the staff team confirming their needs were met 24 hours a day. Comments received from clients included: `I am really impressed with the care and support that I am given here`, `most of the staff are kind and attentive` Staff attitudes are good, they all try very hard`.

What has improved since the last inspection?

A requirement had been made in the last inspection report for information about the home to be provided to all service users by 1st may 2007. On the first day of this inspection 10th May a draft document was available this had not been shared with any of the people living in the home. On the second visit to the home on the 16th may, the document had been reviewed and finalised and copies had been given to the majority of residents. Additional copies were seen to be available for prospective service users. The staff smoking policy has been reviewed and staff are no longer permitted to smoke within the building.

What the care home could do better:

Residents continue to be put at risk. Because: Some peoples needs identified in the pre admission assessments are not met. Care planning continues to be disorganised and of limited or no value in informing staff how to care for residents in a consistent and planned way. Health and personal care needs are not always met because of lack of staff skill and experience. People are at risk of receiving an overdose of medicine due to poor recording practices and are also at risk of harm due to the poor practices in place. Comments received on a returned survey from a visiting health professional suggest the service could improve by listening to the primary care team and following their management plan rather than trying to override the GP and hospital management Individual records seen showed that little effort is made to find out and document resident`s life histories and interests the care plans seen were very much a medical, not person centred model. Despite previous requirements to improve the staff recruitment process further measures to protect residents from people unsuitable to work with vulnerable adults have not been taken.The management culture in this home and poor recruitment practises have the potential to place people who use this service at risk from abuse. Some good practice within the home is undermined by significant short falls in health and safety, staff supervision, quality monitoring and staff management relationships, leading to a poorer outcome for residents.

CARE HOMES FOR OLDER PEOPLE Warberries Nursing Home Lower Warberry Road Torquay Devon TQ1 1QS Lead Inspector Fiona Cartlidge Unannounced Inspection 10:00 10 & 16th May 2007 th 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.V340040.R02.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.V340040.R02.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.V340040.R02.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. 1st March 2007 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.V340040.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this key inspection was to assess the homes compliance with Key National Minimum Standards. The inspectors also reviewed progress on previously set requirements and recommendations communicated following the homes last inspection in March 2007. The site visit took place over 2 days both were unannounced. On the first day the lead pharmacist for the South West Region for CSCI (Commission for Social Care Inspection) accompanied the inspector and on the second day a Regulation Manager of the CSCI accompanied the inspector. A partial tour of the home was undertaken when some bedrooms and all communal areas were viewed. Three residents had their care case tracked, this means their records were examined in detail, and these residents were spoken to in depth about the care and services they receive. Ten other residents were spoken with during the visit, as well as 7 members of staff and the registered manager. Personnel records of 3 members of staff and policies and procedures were also inspected. Feedback was also received from a survey returned by a health care professional. What the service does well: There are, organised social activities; details were displayed on the notice board. And included in the ‘service user guide’. Exercise and activity classes are held twice a week and bingo is played weekly. In addition external entertainers on a regular basis supply musical entertainment and this was well received by a number of residents at the time of one of our visits. Residents said they enjoy the food at the home, the chef and some residents spoken to confirmed alternatives are provided if people do not want the set dish of the day. A resident’s daughter said: “My mother enjoys all the meals provided for her”. The dining room is attractively laid; some choose to eat in their own accommodation. 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.V340040.R02.S.doc Version 5.2 Page 6 Most of the residents were complimentary about the staff team confirming their needs were met 24 hours a day. Comments received from clients included: ‘I am really impressed with the care and support that I am given here’, ‘most of the staff are kind and attentive’ Staff attitudes are good, they all try very hard’. What has improved since the last inspection? What they could do better: Residents continue to be put at risk. Because: Some peoples needs identified in the pre admission assessments are not met. Care planning continues to be disorganised and of limited or no value in informing staff how to care for residents in a consistent and planned way. Health and personal care needs are not always met because of lack of staff skill and experience. People are at risk of receiving an overdose of medicine due to poor recording practices and are also at risk of harm due to the poor practices in place. Comments received on a returned survey from a visiting health professional suggest the service could improve by listening to the primary care team and following their management plan rather than trying to override the GP and hospital management Individual records seen showed that little effort is made to find out and document resident’s life histories and interests the care plans seen were very much a medical, not person centred model. Despite previous requirements to improve the staff recruitment process further measures to protect residents from people unsuitable to work with vulnerable adults have not been taken. Warberries Nursing Home DS0000059901.V340040.R02.S.doc Version 5.2 Page 7 The management culture in this home and poor recruitment practises have the potential to place people who use this service at risk from abuse. Some good practice within the home is undermined by significant short falls in health and safety, staff supervision, quality monitoring and staff management relationships, leading to a poorer outcome for residents. 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.V340040.R02.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.V340040.R02.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 adequate. This judgement has been made using available evidence including a visit to this service. Adequate information about the facilities and services offered at the Warberries is now available to prospective service users. Most prospective service users have an assessment of their needs performed before admission to the home, some people are still admitted despite required resources not being in place. This home is not registered to provide intermediate care. EVIDENCE: A requirement had been made in the last inspection report for information about the home to be provided to all service users by 1st may 2007. On the first day of this inspection 10th May a draft document was available this had Warberries Nursing Home DS0000059901.V340040.R02.S.doc Version 5.2 Page 10 not been shared with any of the people living in the home. On the second visit to the home on the 16th may, the document had been reviewed and finalised and copies had been given to the majority of residents. Additional copies were seen to be available for prospective service users. The document is currently available in written format although some people who use this service have sensory impairments. The ‘service user guide’ contains copies of the contract of admission, but in the documents seen that are held on behalf of those living in the home none had been signed by the residents or their representatives. The records held on behalf of three people living in the home were examined. These contained preadmission assessments performed by external health and social care staff. Some needs identified in the pre admission assessments such as ‘requires an air mattress’ had not been met. For one-person needs identified prior to their admission 6 weeks earlier had still not been met. Another identified therapeutic need was to have a hydro bath regularly but when asked the resident confirmed they had not had a bath since their admission although they said they would like one. Records seen supported this residents’ statement. Warberries Nursing Home DS0000059901.V340040.R02.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): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care planning continues to be disorganised and of limited or no value in informing staff how to care for residents in a consistent and planned way. Health and personal care needs are not always met because of lack of staff skill and experience. People are at risk of receiving an overdose of medicine due to poor recording practices and are also at risk of harm due to the poor practices in place. Residents are not always treated with respect. EVIDENCE: Warberries Nursing Home DS0000059901.V340040.R02.S.doc Version 5.2 Page 12 The care of three residents was examined in detail. This involved meeting them, reading plans of how their care should be delivered and the records of care delivered. Only one of the residents when spoken to confirmed they knew about the records held on their behalf. One resident told the inspector they did not like being disturbed at night, their records stated ‘doesn’t like anyone going into their bedroom or nurses checking on them at night, but we have explained we have to do so. This indicates that the staff do not always respect the wishes and rights of those living in the home. Another resident spoken to voiced their concern about their lapses of memory but their care plan records mentioned neither anxiety nor memory loss. Without a plan to meet these needs staff may not be able to support this person in a consistent and appropriate manner. There was nothing to suggest residents have any involvement in their care plans, or care staff in using them. The records of care provided highlight the disorganised care management. A daily review record of one resident indicated they had suffered an injury following an incident when they had been manually lifted from a bath. The records indicate pain being suffered over a prolonged period, however there was no corresponding plan on how staff should care for this aspect of the person’s needs. Any incident resulting in injury to a person living in the home should be documented to enable assessment and plans to prevent reoccurrence; there was no such documentation available. The matron was able to show care plans that she has recently reviewed, saying she is working toward improving all of them. However, there has been a recommendation to improve the standard of care planning since November 2006. Records and observation of practise at the time of our visit show that staff routinely talk to general practitioners and receive medication prescription advice by phone without face to face consultation between the patient and the doctor. This poses a risk to residents because nurses (not trained or experienced to do so) take diagnostic responsibility for prescribed treatments. Records of specimens sent for analysis, particularly urine, show that some specimens are incorrectly labelled by staff at the home about the type of specimen being sent-; this poses a risk as people may be prescribed antibiotics based on incorrect information, which in turn may lead to reducing sensitivity to antibiotics for those living in this home. Comments received on a returned survey from a visiting health professional suggest the service could improve by listening to the primary care team and following their management plan rather than trying to override the GP and hospital management. The records of one resident showed that they required a specific bandaging technique to maintain and improve their condition. Records show that only Warberries Nursing Home DS0000059901.V340040.R02.S.doc Version 5.2 Page 13 one member of staff had the skills and experience to perform the task. It became apparent that this person’s needs could not be fully met if this member of staff was not on duty. This had been an ongoing problem over a number of months. We found that some hand written entries on the Medicine Administration Record (MAR) charts indicated that the person was receiving a 10 times overdose, this person was also looking after their own medicine although there was no record of the supply of medicine to them to carry out this task. The qualified staff on duty at the time had not noticed the error in the recorded dose, nor had any of the other staff that had administered the medicine since 25th April 2007. We were also unable to find a risk assessment in place regarding the self-administration of medicine for this person. We also found that the records were unclear. Examples of this were a nurse using a single initial to record administration when this initial was used on the code at the bottom of the sheet to indicate non-administration, a person prescribed doses of an anti coagulant that was not clear what tablets had actually been received or what combination of tablets had actually been administered. We also found that the application of creams and other external products is only recorded if the nurse carries out the task or witnesses the carer doing it. For all other applications no record is made. This means that it is not possible to ensure that people are having creams applied as prescribed. We found that for some people prescribed a variable dose that no record is made of the actual dose they have been given. We also found that the nurse administering these medicines was not able to access information in the person’s care plan to indicate how to monitor the pain the person was experiencing or how to decide what dose was required. We found loose and unlabelled medicines in both the medicine trolleys and in the storage cupboards. Some of these were prescription only medicines and can only be administered to the person they have been prescribed. We found that the current temperature of the fridge is only recorded weekly. This means that it is not possible to demonstrate that these medicines have been stored in accordance with the manufacturers instructions and their potency may have been affected. We also found an opened and unlabelled insulin pen. As this was not dated when opened it was not possible to determine if this medicine was still in date. We also found that the medicine storage room had a radiator turned on that was adjacent to stored medicines. This means that the temperature of these medicines was above that recommended by the manufacturer. Also the window to the room was open and this could be accessed from the flat roof below due to the positioning of a ladder outside. We found that some medicines were transported from the medicines room to the people’s rooms in unlidded pots. This can pose a danger of spillage and loss if the member of staff were to trip. We checked the Controlled drugs records and found them to be in balance. However for many other medicines the stock levels were high and pointed to a Warberries Nursing Home DS0000059901.V340040.R02.S.doc Version 5.2 Page 14 lack of stock control. We also found many out of date sterile products that may compromise the care given to the people in the home. Warberries Nursing Home DS0000059901.V340040.R02.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lifestyle in the home does not meet the social and recreational needs of all people living in the home. Residents are able to maintain contact with family and friends. Residents receive a wholesome, appealing diet but not all are aware of the choices that are available. EVIDENCE: There are, organised activities; details were displayed on the notice board. And included in the ‘service user guide’. Exercise and activity classes are held twice a week and bingo is played weekly. In addition external entertainers on a regular basis supply musical entertainment and this was well received by a number of residents at the time of one of our visits. Warberries Nursing Home DS0000059901.V340040.R02.S.doc Version 5.2 Page 16 Individual records seen showed that little effort is made to find out and document resident’s life histories and interests the care plans seen were very much a medical, not person centred model. Residents said they enjoy the food at the home, one was not aware that they should have a choice of menu for each meal. The menu provided and included in the service user guide for lunchtimes does not include an advertised option to the main meal, however the chef and some residents spoken to confirmed alternatives are provided if people do not want the set dish of the day. A resident’s daughter said: “My mother enjoys all the meals provided for her”. The dining room is attractively laid; some choose to eat in their own accommodation. 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.V340040.R02.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People cannot be confident that their complaints will be listened to, taken seriously or acted on. The management culture in this home and poor recruitment practises have the potential to place people who use this service at risk from abuse. EVIDENCE: The record of complaints held in the home was seen on both visits. At the time of the first visit few complaints had been documented, at the time of the last inspection some residents were heard to grumble or raise issues with us which were passed on to the staff in the home. On our second visit a number of complaints had been documented. The book appears to be the only documentation of complaints. Complainants do not receive written acknowledgement or feedback on outcomes of their complaints. This is in contradiction to the homes own complaints procedure, which has been included in the service users guide. The procedure provides contact details for CSCI but lacks the address of the Director of Social Services despite a statement in the procedure advising those who are funded through social services to contact them. Staff training records indicate that most staff have received training on how to recognise and report allegations or incidents of abuse or neglect. However, Warberries Nursing Home DS0000059901.V340040.R02.S.doc Version 5.2 Page 18 one resident reported an incident to us at the time of the visit, advising they had subsequently voiced their concern about an incident the evening before (which had made them feel very upset) to both the night care staff and a carer. When we disclosed this to the senior staff on duty they were unaware of the incident. This is in contradiction to the protection of vulnerable people policy which advices staff to report allegations to senior staff in the home. The overall atmosphere in the home is not conducive to encouraging staff or residents to raise concerns. We were told of concerns but asked not to let the senior staff in the home know who had raised them. This does not evidence an open and positive management approach to criticism or complaint. Warberries Nursing Home DS0000059901.V340040.R02.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): 19,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment is homely, comfortable and meets resident’s expectation, but safety and hygiene are not sufficiently managed. EVIDENCE: Resident’s rooms are homely and comfortable; they contain many personal items of importance. A staff member said: “We respect the resident’s wishes, listen to relatives comments and provide a good homely environment”. Most evidence suggests this is true. Some items of furniture look old and damaged - the leg on one divan bed was seen to be faulty this was reported to staff for action at the time of our visit. Warberries Nursing Home DS0000059901.V340040.R02.S.doc Version 5.2 Page 20 The home was generally fresh, warm and pleasant. Comments received include: “My mother has settled in well and is extremely happy. She loves her room, likes all the staff and considers the home to be her home from home”. Antibacterial hand gel and protective clothing are available as are handwashing facilities for staff use in all parts of the home including resident’s bedrooms. During the inspection a dried piece of cat faeces was seen on the carpet in the main corridor between lounge and dining room, it appeared to have been there for some time. Most doors to bedrooms and bathrooms have been fitted with locks however one bathroom, which has 2 doors leading into it, has only one of these fitted with a lock and there were no notices that would display when the room was in use. This bathroom also had two ceiling wires with light bulbs, both without light shades; in addition the flooring in this bathroom was badly discoloured all around the toilet. This portrayed the room as institutional, paying no respect to people’s privacy and dignity; it is of an unacceptable standard. A number of areas both internally and externally need attention, work was seen underway to repair ceiling and roof leaks during both our visits one resident told us of a narrow escape from a leak over their bed which had been unsuccessfully patched and was now undergoing more extensive repair externally; internally the water stains were still clearly visible. Carpets in some areas particularly in a first floor corridor were stretched and ruffled presenting a trip/fall risk. The flooring in a wet/shower room was poorly fitting also presenting a risk to residents and staff In the garden and patio areas there were various bits of damaged furniture left in full view of the residents lounge window, some rotten roofing material had been left in a pile and an empty box was left all day on steps leading to the home. Generally the environment needs to be greatly improved to provide a pleasant and safe place for people to live and work in. Communal areas in the home include a large lounge, dining room and conservatory all on the ground floor. Residents are able to smoke in the conservatory and in their own rooms following risk assessment. The conservatory ceiling showed a number of signs of water ingress. The staff smoking policy has been reviewed and staff are no longer permitted to smoke within the building. There is no dedicated staff room for the staff to take their breaks. Warberries Nursing Home DS0000059901.V340040.R02.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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are not always sufficient numbers of staff with the skills and experience required to meet the needs of all residents. The homes recruitment practice does not fully protect residents from being placed at risk of harm or abuse. The standard of induction training for new employees has improved, some training needs are unmet. EVIDENCE: Three Personnel files were examined, these records showed a lack of commitment to safe recruitment practices. The files lacked written references, copies of required work permits, and one member of staff employed since July 2006 still does not have a returned Criminal Record Bureaux check. Individual training records (personal development plans) provided evidence that training is provided and ongoing. Staff spoken to on the day of the site visits confirmed they received sufficient training to enable them to meet the needs of those living in the home. Most staff are encouraged to gain National Vocational Qualifications. Warberries Nursing Home DS0000059901.V340040.R02.S.doc Version 5.2 Page 22 The residents were complimentary about the staff team confirming their needs were met 24 hours a day. Comments received from clients included: ‘I am really impressed with the care and support that I am given here’, ‘most of the staff are kind and attentive’ Staff attitudes are good, they all try very hard’. Records and discussions and observation of practice confirmed that there have been a number of incidents particularly at weekends when there has been a shortage of staff. Staff confirmed that when they are absent they rely on other employees to cover the shift. We were told that the home does not want to use agency staff because they do not know the layout of the home or the residents and this causes more problems for the homes own staff. The records of one resident showed that they required a specific bandaging technique performed to maintain and improve their condition. Records show that only one member of the homes staff had the skills and experience to perform the task. It became apparent that this persons needs could not be fully met if this member of staff was not on duty. This training need has been recognised but the training had not been performed at the time of our visits. This had been an ongoing problem over a number of months. Warberries Nursing Home DS0000059901.V340040.R02.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): 31,33,35, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some good practice within the home is undermined by significant short falls in health and safety, staff supervision, quality monitoring and staff management relationships, leading to a poorer outcome for residents. EVIDENCE: The day to day care continues under the leadership of a manager known at the home as matron. Residents know the matron well but some have said they do not see her very often since the expansion of the home. Whilst residents appear well cared for, some family and health care professionals are not happy with the service at the home, several of the Warberries Nursing Home DS0000059901.V340040.R02.S.doc Version 5.2 Page 24 previous requirements and recommendations for improvement remain unmet, despite the risk to residents. They include poorly recorded administration records for medicines and poor recruitment processes and some very poor care planning. In addition on this occasion were poor record keeping and security of records and unsafe management of the financial affairs of some residents. Health care professionals say the manager’s attitude is not conducive to good professional relations, that communication between the home and outside professionals has deteriorated. Some staff talk of lack of communication and a lack of information, they want more opportunity to discuss issues of importance to them. Comments include: “I want the manager to improve communication to avoid misunderstandings within the home and so all staff are informed of the necessary information relevant to resident’s needs”. One added: “I think morale in the home is low”. The manager showed records of staff meetings, these are held irregularly and the method of recording indicates an authoritarian approach rather than one of encouragement enablement and inclusion. A yearly quality survey of opinion on the home is being devised and we were told this will be given to residents and other stakeholders and the findings will be used to affect the way in which the service is delivered. Many letters of thanks and appreciation are received at the home. However, quality monitoring does not include the standards of work; staff are not sufficiently supervised, this leading to some unacceptably poor health and safety practice including inappropriate and dangerous moving and handling practices. Staff spoken to told us they receive the support they need to do their work. Their opinion is not sought as part of the home’s quality assurance. There are issues that need to be resolved between management and some staff members. Following the March key inspection the manager engaged professional assistance to address the difficulties she was experiencing in addressing quality monitoring issues in the home. Despite administrative support the requirement to keep certain records in the home is not fully met. The registered persons have delegated the duty of acting as appointee to a member of staff despite a legal requirement for them to ensure, so far as is reasonably practical, that persons working at the care home do not act as agent for residents. The person with this responsibility confirmed that they are where possible contacting family members of the residents and legal representatives to take over this responsibility. Where residents are unable to take financial responsibility their financial affairs should be managed either by family or legal advocate. Throughout the inspection, as detailed throughout the report the manager and provider have again 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 Warberries Nursing Home DS0000059901.V340040.R02.S.doc Version 5.2 Page 25 requirements made in relation to provision of information to residents about the service, care planning, recruitment and maintenance practices. Warberries Nursing Home DS0000059901.V340040.R02.S.doc Version 5.2 Page 26 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 1 8 2 9 1 10 2 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 2 2 X X X X X 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 1 X 1 X 1 X X 2 Warberries Nursing Home DS0000059901.V340040.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1) Requirement Timescale for action 01/06/07 2 OP7 15 3 OP9 13(2) To prevent the risk of peoples needs not being met following their admission to the home. The required resources identified on the persons preadmission assessment must be in place and available at the home at the time of the persons admission. Service users plans must set out 20/07/07 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. To prevent the risk of people not 31/05/07 receiving medicines as prescribed you must ensure that all hand written entries are accurate and that all administrations of medicines are recorded, including the dose actually administered. Previous timescale 01/05/07 not met. Warberries Nursing Home DS0000059901.V340040.R02.S.doc Version 5.2 Page 28 4 OP9 13(2) 5 OP10 12(4) (a) 6 OP19 23 (2) (b)(d) Medicines must be stored securely and within the temperature range as specified by the manufacturer to ensure that unauthorised access is prevented and that medicines work as intended. To protect the privacy and dignity of people who use this service, where doors to bathrooms or WCs are not fitted with locks signs should be used to indicate when they are in use. To ensure the premises is of sound construction and kept in a good state of repair the registered provider must record a programme of maintenance and renewal of the fabric and decoration of the premises which includes provision for safe roofing, flooring, bathing facilities and grounds that are tidy, safe and accessible to people who use the service. To ensure people who use this service are safeguarded from abuse or neglect the registered person must ensure all staff know about the written policies and adhere to them. To ensure the homes staff have the knowledge and skills to care for the range of needs of the people who use this service training must be given appropriate to the work they perform. This relates to the lack of suitably trained and experienced personnel who are competent to meet the needs of a resident with specialist tissue viability care needs. The registered person must not employ a person to work at the DS0000059901.V340040.R02.S.doc 13/06/07 01/06/07 01/08/07 7 OP18 13(6) 01/07/07 8 OP30 18 (1) C 01/07/07 9 OP29 19 01/06/07 Page 29 Warberries Nursing Home Version 5.2 10 OP33 26 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 and 01/05/07] The registered provider must 01/08/07 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 01/08/06 & 01/12/06] 11 OP24 16(2) The registered person must having regard to the needs of service users provide suitable bedding and equipment to meet 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. DS0000059901.V340040.R02.S.doc 01/06/07 12 OP26 13(4) 20/07/07 Warberries Nursing Home Version 5.2 Page 30 This relates to staff smoking in the home resulting in service users and visitors being submitted to passive smoking. 13 OP31 10(1) The registered person and the registered manager must having regard to the size of the care home, the statement of purpose and the number and needs of service users, carry on or manage the home with sufficient care competence and skills. This relates to the consistent failure to meet the requirements and recommendations from previous inspection reports and to improve the standards of care and welfare for people who use the service. The registered person must ensure so far as possible that persons working at the care home do not act as the agent of a service user. This relates to an employee acting as appointee for a number of people who live at the home. The registered manager must ensure so far as is reasonably practical the health safety and welfare of service users and staff this relates to moving and handling; use of techniques for moving people and objects that avoid injury to service users or staff. 01/09/07 14 OP35 20 (3) 01/09/07 15 OP38 13(5) 01/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000059901.V340040.R02.S.doc Version 5.2 Page 31 Warberries Nursing Home 1 2 Standard OP1 OP8 2 3 OP9 OP12 It is recommended that information about the service is provided in formats suitable for intended residents for example those with sensory impairments. It is recommended to ensure people who use this service have access to health care services to meet their assessed needs that the manager improve her professional relations with visiting and hospital based health and social care professionals. It is recommended that the service put in place a regular date checking system to prevent the risk of using out of date products. It is recommended that up to date information about activities should be circulated to all service users in formats suited to their capacities. It is recommended that all staff follow the homes complaints procedure. It is recommended that a Cleaning schedule be implemented to ensure all parts of the home are kept clean, hygienic and free from offensive odours. It is recommended that effective quality assurance and quality-monitoring systems are put in place to monitor the homes success in meeting the aims and objectives and statement of purpose. 4 5 6 OP16 OP26 OP33 Warberries Nursing Home DS0000059901.V340040.R02.S.doc Version 5.2 Page 32 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.V340040.R02.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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