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Inspection on 12/01/06 for Warberries Nursing Home

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

This inspection was carried out on 12th January 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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?

Doors to individual accommodation have been fitted with `safe` hold open devices, this has improved the over all safety to residents should a fire ever occur. Suitable hand washing facilities were seen to have been put in place for staff in resident`s bedrooms this will encourage good hand washing practise and reduce the risk of cross contamination when carers move from one resident to another to provide care.

What the care home could do better:

The registered provider must ensure that people that are admitted to this home fall within the conditions of the homes registration - this is to ensure that the specialist needs of all residents are consistently met. Staff responsible for administering and recording medication must ensure that they follow the legal order (Label on bottle) or have the order changed in writing by the prescribing doctor this will ensure all residents receive their medication as prescribed by their general practitioner. All staff should receive up to date training and supervision of practise to ensure good fire safety practise and moving and handling of residents and appropriate use of protective clothing (gloves); this will negate risks to resident safety through fire doors being blocked or residents being transferred/transported in an un-safe manner, or contamination through the inappropriate use of disposable gloves as was witnessed at the time of the inspection.

CARE HOMES FOR OLDER PEOPLE Warberries Nursing Home Lower Warberry Road Torquay Devon TQ1 1QS Lead Inspector Fiona Cartlidge Unannounced Inspection 12th January 2006 10:20 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.V269973.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Warberries Nursing Home DS0000059901.V269973.R01.S.doc Version 5.1 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 28 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 (14), Physical disability over 65 years of age (14) Warberries Nursing Home DS0000059901.V269973.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd August 2005 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 both communal rooms. The Warberries is registered to provide nursing and or personal care to a maximum of 28 residents of either gender who are over the age of 65 years. There is a registered nurse on duty at all times. The home is owned by Mr Mark Titcombe whom is the Registered Provider, day to day management of the home is done by a registered Nurse Manager. 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 with sea views and a smaller conservatory area on the first floor. Bedroom accommodation is offered in 24 single rooms, of which the majority have en-suite facilities, and 2 double rooms. Warberries Nursing Home DS0000059901.V269973.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 3 hours 20 minutes and was unannounced. This was the homes second statutory inspection of the year 2005-2006 readers may wish to consider the content of both reports to gain a full picture of the homes achievements. A partial tour of the home took place when some bedrooms and all communal areas were viewed. Individual records of care held on behalf of 3 residents were inspected. The inspector spent the majority of the time talking with 15 residents, and took time observing actual practise. What the service does well: All of the residents spoken to confirmed that the staff are kind, helpful and hardworking. Comments received at the time of the inspection included: - ‘Its very nice here’ ‘the food is very good, we get plenty of choice’ ‘the staff are lovely and matron is brilliant’. Feedback about the food served in the home was good, people said it was of good quality and served in ample portions, options to the main dish are always available and individual dietary needs are catered for. Resident’s said that the activities arranged and offered in the home suited their needs and preferences. A notice was displayed that advertised an organised activity for every day of the week these included exercise sessions, board games, bingo, trips out, aromatherapy, reminiscence and videos. Some residents stated that they preferred to spend time in their own rooms and this was respected. The environment is bright, clean and cheerful the décor and furnishings in bedrooms are based on the individual choice of those living with in them most bedrooms and 2 large communal rooms have either breathtaking views over the bay or overlook the garden. Well recorded and regularly reviewed documented care plans were in place, these had been formulated following thorough assessment of individual needs and provided a basis for the good quality consistent care that was given by the staff team. Warberries Nursing Home DS0000059901.V269973.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: 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. Warberries Nursing Home DS0000059901.V269973.R01.S.doc Version 5.1 Page 7 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.V269973.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1.2.3. The admissions procedure is safe; it enables the staff to make a professional judgement about how the needs of individuals will be met. EVIDENCE: The inspector spoke to a number of residents who had recently been admitted to the home. One resident told the inspector they had made their decision about moving to the Warberries after receiving written information about the home and had not felt the need to visit before committing themselves. Another recently admitted resident had spent a temporary period in the home before arranging for their long- term admission. Both residents indicated that they felt they had made the right decision and said they were settling in well. The inspector examined the personal records held within the home on behalf of 3 of the residents these contained copies of contracts/terms of residency. All three records contained evidence that a full and detailed assessment had been performed on the resident prior to their admission. The inspector found that information about the individuals’ health, personal and social care had been sought to enable the registered nurses to make a professional judgement about how needs will be met before offering the individual the opportunity of admission. Warberries Nursing Home DS0000059901.V269973.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9 The health care needs of residents are regularly reviewed and action is taken to meet those needs. Nurse’s handwriting medication administration records and altering those that have been printed by the supplying pharmacist could result in medication being administered incorrectly - this poses a risk to residents and is in conflict with the Nursing and Midwifery Council (NMC) code of conduct. EVIDENCE: The home provides a comprehensive care planning process for residents, based on continual assessment of their needs. Three care plans viewed during the inspection were fully completed and appropriately reviewed and showed evidence that the residents had been involved in the formation of the plan. Documentation provided evidence that General Practitioner’s, chiropodist, dentist and opticians visit residents and that they are referred to specialist community and hospital health specialists when necessary. Registered nurses manage the medication system; the inspector looked at storage and recording – there was no controlled drug stock at the time of this inspection. Stocks of all other medication appeared slightly excessive - the Warberries Nursing Home DS0000059901.V269973.R01.S.doc Version 5.1 Page 10 nurse in charge explained that a double order had been received due to the Christmas/New year holiday period and that medication no longer in use had not been disposed of because the safe system now required for this purpose was yet to be put into practise. Records provided evidence that a legal order to change the prescribed administration times had not been sought when it should have been. A requirement to stop this risky practise has been made in this report. Warberries Nursing Home DS0000059901.V269973.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15 Social activities are organised and meet the needs of the residents. Meals are nutritious and balanced and offer a healthy and varied diet for residents. EVIDENCE: Resident’s said that the activities arranged and offered in the home suited their needs and preferences. A notice was displayed that advertised an organised activity for every day of the week these included exercise sessions, board games, bingo, trips out, aromatherapy, reminiscence and videos. Some residents stated that they preferred to spend time in their own rooms and this was respected. The feedback about food was extremely positive all of the residents spoken to said how good it was; Lunch was served at the time of the inspection which was Roast Pork with vegetables and potatoes followed by fruit pie and custard. Some residents eat their meals in the dining room, some in the lounge and some in their own rooms. Breakfast is served in the residents rooms and includes a choice of cereals, toast or cooked breakfast, supper is served at 6.00pm and a cooked option is usually available ensuring residents are able to have 2 or 3 cooked meals on most days. Warberries Nursing Home DS0000059901.V269973.R01.S.doc Version 5.1 Page 12 Warberries Nursing Home DS0000059901.V269973.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were inspected on this occasion. EVIDENCE: Warberries Nursing Home DS0000059901.V269973.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The home is clean and well maintained with suitable equipment to meet the needs of people with physical disability/frailty. There is a risk of cross contamination between residents because some staff wear protective gloves and do not change these and/or wash their hands between care duties. EVIDENCE: Warberries Nursing Home DS0000059901.V269973.R01.S.doc Version 5.1 Page 15 A tour of the building confirmed that the home appeared well maintained. Repairs/redecoration take place on a need to do and informal basis, the home employs 2 maintenance persons. During the inspection there was evidence of some building work as the home is being enlarged through the conversion of the next-door property to meet the needs of people with disability, frailty or illness; residents told the inspector that the building work was not affecting them and one said they were looking forward to moving into the new accommodation. The home has three main communal areas. On the ground floor the home has a large lounge and dining area with sea views. On the first floor is a conservatory area with seating and books. Bedrooms were all seen to be comfortably and pleasantly decorated on an individual basis. Observation confirmed that Service users are given an option and were seen to provide their own furnishing. The property was clean, tidy and free from offensive odours on the day of inspection. The inspector observed 2 care staff wearing gloves these carers had assisted a resident with personal hygiene needs and relocation to the lounge where they then assisted other residents with care duties without removing the gloves they were wearing. This poor practise was discussed with the qualified staff at the time of the inspection whom brought it to the attention of the carers. It was also noted that a tub of skin cream was left unattended in a bathroom on examination the tub contained no information for whose use it was. Warberries Nursing Home DS0000059901.V269973.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 The number and skills of staff available in the home meets the needs of those living in the home. EVIDENCE: On the day of the inspection there were 27 residents with varying needs in the home. On duty at the time of the inspection was 1 Registered Nurse and 6 care assistants, 1 administrator who is also a qualified nurse, 2 maintenance persons, and 3 domestic staff and 2 catering staff. The manager also came on duty during the inspection. Residents spoken to said there was usually enough staff on duty, 2 residents commented on how busy the manager is because of the conversion and building works. All residents spoken to said there needs were being met. Warberries Nursing Home DS0000059901.V269973.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 Fire exits are not always left clear, this poses a potential risk to the safety of residents, staff and visitors should a real fire occur. EVIDENCE: The fire alarm sounded during the inspection and staff were observed to leave what they were doing and attend the fire board in an efficient and timely manner, unfortunately the doors to 2 rooms that were being wedged open at the time for cleaning purposes were left wedged open and the inspector observed that a carpet cleaner had been left propped against a fire exit door. The inspector was found by the staff team to be the only person not accounted for and a member of staff was deployed to find her. The issues relating to auditing the process were discussed to promote safer future practise. The home appeared well equipped to meet the needs of those residents identified with moving and handling risks and disabilities however during observation of practise the inspector saw one carer transporting a resident in a Warberries Nursing Home DS0000059901.V269973.R01.S.doc Version 5.1 Page 18 wheelchair; the chair had no foot rests and was tilted back dangerously and frighteningly to prevent the residents feet being in contact with the floor surface. On another occasion 2 carers were seen transferring a resident from wheelchair to arm chair using a transfer belt the resident did not have time or explanation about the need to weight bear and so was seen being inappropriately manually lifted. It was found that one resident had been admitted below the age limit of 65 years as specified in the homes categories of registration an immediate requirement to apply to the Commission to vary the conditions to include 1 service user (named elsewhere) under the age of 65 years was made at the time of the inspection. Warberries Nursing Home DS0000059901.V269973.R01.S.doc Version 5.1 Page 19 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 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 Warberries Nursing Home DS0000059901.V269973.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) Requirement Timescale for action 01/02/06 2 OP26 13(3) 3 OP38 4(1)© schedule 1 The registered person must make arrangements for the recording, handling, safe keeping, safe administration and disposal of all medicines received into the care home. The registered person must 01/02/06 make suitable arrangements to prevent infection, toxic conditions and the spread of infection in the care home. The registered person must 12/01/06 apply to vary the conditions of the homes registration to ensure it continues to operate legally. 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 OP38 Good Practice Recommendations Staff should be made aware that fire doors should be kept closed when not in use, fire exits must be kept clear at all times and residents must be transported and transferred DS0000059901.V269973.R01.S.doc Version 5.1 Page 21 Warberries Nursing Home safely within the home at all times Warberries Nursing Home DS0000059901.V269973.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V269973.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!