Inspection on 08/08/07 for Warberries Nursing Home

This inspection was carried out on 8th August 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.

Other inspections for this house

Warberries Nursing Home 10/05/07

Warberries Nursing Home 01/03/07

Warberries Nursing Home 01/06/06

Warberries Nursing Home 12/01/06

Warberries Nursing Home 02/08/05

Warberries Nursing Home 06/01/05

Warberries Nursing Home 19/10/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Poldhu

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

CARE HOMES FOR OLDER PEOPLE Warberries Nursing Home Lower Warberry Road Torquay Devon TQ1 1QS Lead Inspector D Endean Unannounced Inspection 08:00 8 , 9 & 16 August 2007 th th 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.V343445.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.V343445.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 www.warberriesnursinghome.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.V343445.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. 10th May 2007 Date of last inspection Brief Description of the Service: The Warberries is a large, extended, grade II listed Victorian property, situated in a quiet residential area of Torquay. The property has sea views across Torbay from some rooms including from the communal areas. The Warberries is currently registered to provide nursing and/or personal care to a maximum of 49 people of either gender who are over the age of 65 years. As nursing care is provided there is a Registered nurse on duty at all times. Red Healthcare Ltd owns the home and there is a Registered Manager, who is also a Registered Nurse, who is responsible for the day-to-day management of the home. The accommodation is provided over 3 floors that are accessed by passenger lift, stair lift or stairs. Adapted toilets and bathing facilities are available for the people who live in the home. The home has nursing equipment, such as height adjustable beds and hoists, to meet the needs of people who require nursing. Communal rooms comprise of a large lounge and a separate dining room on the ground floor, and a large conservatory. There is also a small ‘quiet room. A large entrance hall and reception area provides further seating and contains a pool table. Bedroom accommodation is offered in 41 single rooms and four double rooms, of which the thirty-seven rooms have en-suite facilities. The grounds include seating areas and a swimming pool. Information about the home was found in the entrance hall, people can request a copy of the latest inspection reports from the administration office. There is also an internet website and brochures that provide information about the service and the colourful history of the building. Information given to the Commission by the provider indicates the current range of fees is from £490 to £560 per week. Additional charges are made for chiropody, hairdressing, newspapers/magazines and personal toiletries. Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced key inspection took place over a three-day period. On the 8th August 2007 two inspectors were at the home. They read administrative and service users records. One inspector then concentrated on service users and staff. Two service users were interviewed and a number of care staff. The other inspector made a tour of the premises including the treatment room, laundry and kitchen areas. He also interviewed the Registered Manager. On the 9th August one inspector returned to the home and spent more time looking at the way the home records information and communicates this to others. On the 16th August the same inspector carried out a further inspection of the premises and discussed the management style with the Registered Manager, the Provider and the Administrator. A sample group of three staff records were read in detail and the records of eight people living at the home were read. We spent time talking with nine people who live in the home and many staff providing the care and ancillary services. In addition to this the Registered Manager provided the Commission for Social Care Inspection with a completed Annual Quality Assurance Assessment form that told us how the home has viewed their own performance, and gave some factual information about how it has functioned. We received 12 completed service users survey forms, some having been completed with the aid of the homes staff. We sent surveys to 10 relatives and had seven completed forms returned. We also surveyed three General Practitioner practices that have patients in the home. From a total of 23 forms that were sent out two were partially completed and returned. One General Practitioner did reply saying that they do not visit this home. What the service does well: The home provides good clinical care to the people who live in the home. They communicate well with them and their relatives. The people who live in the home, and the relatives who were able to comment, appear to be happy and satisfied with the care and service that is provided to them. The organisation that goes into preparing the right meal for people is very good, and the food that is provided at the home is very well received by the people who live there. The people who responded in the surveys who live in, or visit the home, mostly said that the staff are kind and caring towards them. Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 6 There are various planned activities that are enjoyed by many of the people who live in the home that have a therapeutic outcome or are just good entertainment. 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. Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 7 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.V343445.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.V343445.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): The homes performance was assessed against Standards 1 & 3. Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a good level of information about the service they intend to provide to anyone who requests it. The information gained before an individual is admitted to the home is of a good standard and does allow them to make adequate preparations for the admission. EVIDENCE: The home has information about its services on display inside the front entrance on a large table. The service users guide contains information about the service and facilities available at the home. One page provides information about who are employed and their qualifications. It also provides information Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 10 about rules and restrictions about living there such as policies on keeping pets and smoking. There is a copy of the homes contract of residency included. Copies of this information can be found in each of the bedrooms. The home said that they could provide a large print copy if one is requested. The home also has its own website for those who have internet access. The table also had information displayed about how people can fund their placement and letters of commendation from families and friends of people who had lived at the home. The service users guide has been professionally prepared and printed; and in the back there is a history of the building that has now become the nursing home. Also on display in the reception are the certificates of registration and public liability insurance. By the end of the third day of inspection several training certificates had been put up on display. We read the files of six people living at the home. Discussion was held with two of these people on how they came to be at the home. The information gained was compared to that in their files. Both had come from hospital following a period of acute illness and there was information from hospital and social services staff about them in their files. Proof was seen in their files of the information the home got about their needs before they were admitted. This was important as it allowed the manager to make a decision about whether they could meet the needs of the people. It also allowed for time to get any equipment they needed for the people before the admission took place so that they could ensure their care could be continued safely. The Provider has purchased twelve height adjustable beds of a good standard since the last inspection. Warberries Nursing Home DS0000059901.V343445.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): The homes performance was assessed against Standards 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans do possess good levels of information about the medical needs of the people being cared for but in a format that is not easy to read. The care plans do not address the needs of the whole person. The arrangements for managing medication at the home are adequate. The communication and relationship between the home and some health care professionals is not conducive to good patient care. EVIDENCE: The care plans of eight people were read, four of which were read in detail. The plans were based on the homes assessment of people’s needs that were described and how they intended to meet them. The plans are made to help Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 12 each staff member work in the same way with a person and in accordance with their wishes. The plans were written in a standardized format that contained a great deal of information not relevant to each individual person receiving care at the home. The non-relevant sections were crossed out when not relating to an individual. This made the care plans hard to read and identify people’s current needs. The plans did however identify current medical needs of each individual person, but did not show how the problems might impact on the individual as a person. Plans would benefit from more information about peoples social and personal histories. This would help staff understand them the whole person they are caring for. This also has benefits where people might have communication problems such as in dementia. The more person centred approach that covers also the psychological wellbeing of an individual would benefit each person in the home. Before the final day of the inspection the Registered Manager had begun to change the way the care plans were written. Care planning has been the responsibility of the Registered Manager and has not been a shared responsibility with the other Registered Nurses at the home. The people who live at the home and/or their relatives have been involved in the reviewing of their care plans regularly and this helped to ensure that changing needs are being met. Three care plans were discussed in detail with staff looking at the care each person is given on a daily basis. Staff were clear about the care they were giving, and the descriptions of the care they gave were consistent. This included information about communication methods for a person with limited communication. Every person has a bed rail assessment. Where bed rails are present they are reassessed on a daily basis and comments recorded on a sheet that was shown to the inspector. The care plans contained information about moving and handling practices, assessments of pressure area care and risks relating to infection control. Proof was available that showed people are seen by visiting medical and other professional services such as the tissue viability specialist and speech therapist. The two General Practitioners’ that responded to the Commission for Social Care Inspection professional survey did not feel that the management of the home was of an acceptable standard. They both commented on the smoking habits of the staff in derogatory terms. Staff do not now smoke anywhere inside the home. Those who continue to smoke do so in areas within the grounds of the home. There is information displayed about the rules regarding smoking in the home. People who live at the home and who are smokers have been risk assessed for smoking in their own rooms. One General Practitioner said that the manager “doesn’t seem to know when a patient is dying & to treat appropriately”. He then has commented in his responses that the care staff usually have the right skills and experience to support individuals social and health care needs. We assume that the first comment relates to the Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 13 managers enthusiasm to preserve life and not follow the path of a dignified death. We will be discussing this issue with both parties. In contrast of the twelve relatives that responded to the Commission for Social Care Inspection survey only one was unable to make positive comment as their relative had only been in the home a short period of time. All the others were complimentary about the care that is provided and the with such comments like, “I praise the Matron and all the staff at the care home. The love, care and attention my relative receives is keeping her happy everyday.” Another said, “My relative was very ill when he was taken to the Warberries Nursing Home. I feel they have done a great deal to get him back to the condition he is in today”. Finally, “We are very satisfied with the standard of care our relative receives. They appear to be happy and well cared for both by day and night staff. We would recommend this nursing home to anyone”. Medicines are stored in a locked trolley in a locked room. The trolley is also secured to the wall. Following the last inspection one registered nurse has been allocated the task of managing the medication that is ordered, used and returned to the supplying pharmacy. The home uses a monitored dose system for regular prescribed medication. We looked at the recording system and found that there was a clear trail of administration with procurement also being recorded on the administration sheet. There was photographic identification of people who receive medication and a sheet that identified the signature of the individual who had administered it. Hand written entries were clearly written. The home has improved the storage of medication with such things as eye drops being stored at room temperature and a drug fridge being used for those items that require refrigeration. A record of fridge temperatures was seen. They have begun to address the storage problems of dressings and have removed those that were out of date. However the treatment room was cluttered with stock albeit in date. The first aid boxes stored in this room did have some out of date products in it. The dressings storeroom door was neither locked nor able to be locked on first inspection. This had been addressed by the last day of the inspection. During the tour of the home some creams and over the counter medications were found in the bathroom. There were also parenteral feed preparations on a trolley stored in the bathroom. Care was given to the people living at the home in the privacy of their own room or in another appropriate place such as the bathroom or toilet. All the bathrooms, showers and toilets have now been fitted with locks. Bedroom doors are supplied with locks on request. Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides suitable activities. The recording of people’s involvement and responses to the activities are not satisfactory. The meals that are provided are of a high standard and meet with the satisfaction of the people who live in the home. The kitchen is well managed. EVIDENCE: We spent time with nine people who live at the home. Some were very frail and two had limited verbal communication skills. The people who were able to talk about their experience of living at the home said that they enjoyed spending time in their rooms and enjoyed their own company. The case files contained limited information on people’s likes and dislikes and their interests such as one person who liked classical music. Staff said that they usually put classical music on the radio for that individual. The interactions we saw between staff and people living at the home showed that the staff treated Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 15 people with courtesy and respect for their dignity. One person said, “The staff are lovely here. They are like family to me now”. There are organised activities at the home. The manager said that she would like to move towards a more individualised approach to activities. At the present time there are planned activities and these are displayed on a poster in the reception and also in peoples bedrooms. A member of the staff is employed three afternoons a week to carry out activities with the people who live at the home. On two afternoons a week a lady also does exercise classes and one afternoon is allocated for an external entertainer. We saw one of these entertainers holding the attention of the people who live in the home and involving them in singing whilst she played a guitar. Individuals may be actively involved in the activities, they may choose to just watch, or they may stay in their room. The people who live in the home who completed the Commission for Social Care Inspection service users survey forms said such things as, “We have exercises, bingo and lots of music, much appreciated” or, “I choose to have my own company”, and “Love the activities”. For the people who were frail and spent most of their time in bed most contact with the staff appeared to be task based. However staff were clear that they needed to talk to people about the tasks being undertaken. Visiting can take place at any reasonable time and they may use any part of the home or its grounds that is acceptable to the person who lives in the home. The people who live at the home may choose whom they see and do not see. There is a pay phone in the home and the home have a cordless phone that can be used to receive calls by people who cannot use the payphone. People can have their own telephone line in their room that they pay for and several have taken up this arrangement. In this way some people manage a greater control of their personal affairs. The home does not manage the affairs of any of the people who live there but they do collect the pensions for four of the people and have suitable arrangements in place for this now. They also have a copy of the Commission for Social Care Inspection guidance called “In Safe Keeping” that gives advice on supporting people who use regulated care services with their finances that was published in May 2007. We looked at how the meals are prepared, being based on a four week rotating menu. The cook said that she interviews every new person who moves into the home to find out what they like to eat and what they do not like to eat. She had a book where this information was recorded. There was also a board where the drinks that people liked were recorded. Using this information she prepares meals that are provided in a way that each individual can manage such as some items provided as a normal or soft diet and others as a special diet, diabetic, etc, again presented in a way that the people could manage themselves. She also told us that organic poultry and meat substitutes were provided when requested and any religious or cultural needs would be Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 16 addressed. Those who do need help are given it in a respectful way. There are always two choices of main course and several choices of sweet at the main meal of the day. The cook will prepare an alternative if it is requested. Of the twelve completed service users survey forms seven said the food was always good and the others were satisfied with the food. Meals can be had in the dining room, the individuals bedroom and also outside on the patio when the weather is good. We saw evidence that when a person had been discharged home they had been provided with a takeaway meal so that they would have something in the house to eat that evening. The kitchen is well set out with distinct areas and good food storage practices. The cook has also been on the “Safer Food, Better Business”. Training given by the local authority and she keeps good records of food that is provided to individuals. The cook has a wellrun kitchen. Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is now robust. The secondary process that is now in place for service users to air their views, the homes ‘service users survey’ is good. Staff knowledge of the adult protection process and the role they play in it is satisfactory. EVIDENCE: The home has a complaints procedure that has been included in the service users guide. The procedure provides contact details for Commission for Social Care Inspection. A copy of the procedure is also displayed at the front entrance of the home and in every bedroom. There is a complaint log that details any complaints made to the home and the action they have taken as a result of the investigation of the complaint. All complaints are formally responded. The home now use information gained in its service users quality assurance questionnaire as another chance for people who live in the home to air any concerns. This shows a robust approach to responding to complaints and concerns. Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 18 In the Commission for Social Care Inspection relatives survey forms people said that they did know how to make a complaint and one wrote that, “ I would speak directly to the Matron to see if she could sort out any complaint”. There was evidence in the staff files that showed that all staff had received protection of vulnerable adult training. We talked to two staff who told us what they understood about adult protection, and what constituted abuse. They understood their responsibilities in relation to reporting issues of concern and protecting vulnerable people. Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 19, 21, 24 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is comfortable, clean, and odour free but not well managed in some areas. There were areas that needed de-cluttering of hazards and improved decoration. EVIDENCE: The home is located in a residential suburb of Torquay about one mile from the town centre. It has an elevated position that commands good views of the town and Torbay from the front of the home. There is a steep curved driveway to a parking area at the top that has a slight gradient upwards to the front entrance of the home. The exterior of the home has a patio area with seating, and a timber decked area that over looks the swimming pool. The home is a Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 20 large listed Victorian building that has an interesting history that is given in the homes brochure. Inside the home there are a number of communal areas of various sizes including a separate dining room and a conservatory that opens out onto the patio area. There are four double rooms and the rest are single rooms of various sizes and with a variety of outlooks. The majority have en-suite facilities or are near toilet and bathing facilities. There are two shaft lifts that provide access to most of the rooms above ground floor level. During the inspection of the premises we saw that bedrooms were suitably furnished and decorated to the taste of those who lived in them. Most were pleasant with open views over Torbay, but some had less attractive views because of their position in the building. All had a nurse call system that was in good order and this extended to all the areas that the people who live in the home have access too. A variety of beds were provided to meet the needs of the people living at the home. Since the last inspection the Provider has purchased twelve new height adjustable beds of good quality. Some of the décor was in need of improvement and the manager told us that it is part of the ongoing work being carried out. On the first day of the inspection a small number of issues were raised such as the large lounge carpets that was separating at the seam, and short studs protruding from the wall in the conservatory. These were dealt with to a satisfactory standard immediately and the work completed by the second day of the inspection. The exits of the home are covered by intruder alarms that are set by the staff at 17:00 hours every day. Some bathrooms did need attention, one recently refurbished bathroom being left with an uneven floor. Another needed some minor attention to the frame supporting the bath and the clutter in the room. The remaining bathrooms were either good or satisfactory although one other was cluttered and required a window restrictor to be fitted. The bathrooms are suitably equipped to enable disabled people to use them in safety. The builder was carrying out work during the inspection to manage an issue of damp in a wall whilst another area of the home was being redecorated. Several areas were cluttered with equipment, etc, on the first day of the inspection that was cleared by the second day of the inspection. The main lounge was being used by a large number of the people who live in the home on each day of the inspection. Their views about the layout of furniture were obtained on the first day. The lounge was cluttered and the main feature, a large fireplace, was being used to store footplates from wheel chairs. The people in the lounge said that they would like to see the room made more attractive and comfortable. This information was given to the Registered Manager as feedback of the first day of the inspection. On the Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 21 second day of the inspection the room carpet had been repaired, the fireplace cleared and uncovered and the area generally made more pleasing to the eye. There were no curtains and the manager told us that they had ordered new blinds and were waiting for them to arrive. There is no property that overlooks the home at the front, but it did detract from the attractive features of the lounge. We met cleaners around the home who were busy keeping it clean and odour free. They now have a cleaning schedule to guide their work. There were antibacterial hand gel and protective clothing for staff to use in all parts of the home including resident’s bedrooms. We did comment on finding some cleaning fluids on display in two sluice rooms that were not securely closed to people who live in the home. The sluice rooms were also untidy and one bin for infected items that should have had a lid, did not. Also a commode being stored in a bathroom was heavily stained on its frame and needed hygienically cleaning. The home has its own laundry for personal clothing, towels, etc. Bed linen is cleaned under contract and not in the home. The laundry lady works about 6 hours a day five days a week. She has suitable equipment including a washing machine with a sluicing cycle, and a gas clothes dryer that is located outside of the home for Health & Safety reasons. Clothes are labelled so that when they are ironed they can be placed in baskets with people’s names on and delivered to their rooms. Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 22 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): The homes performance was assessed against Standards 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. There are adequate numbers of staff on duty with the skills and experience required to meet the needs of all residents. The homes recruitment and training practices are satisfactory. EVIDENCE: During this inspection period there were thirty-eight people resident at the home. We observed the handover from night staff to day staff on the first day and also from the manager to a registered nurse on the second day. The first handover was to each of the three team leaders who we were told then hand over to the staff they work with. When the care staff were spoken to they did have a good current knowledge of the needs of the people they were caring for. However, the handovers did appear to be a little uncontrolled and noisy. The same occurred when the Registered Manager began her shift with a great deal of noise and uncoordinated information. The Registered Managers handover to the trained nurse on the second day was more professional. The passing of information that was valuable about each person was clear and the handover was not interrupted. Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 23 There was adequate numbers of staff on duty during each day of the inspection. Past time sheets were looked at for the previous two weeks and staffing levels appear satisfactory. There was also a suitable skill mix that included Registered Nurses and care staff who had received in house training on appropriate subjects as well as National Vocational Qualification training in care. One relative said, “The staffing levels at the weekends could do with improving although the girls that are on duty work incredibly hard to maintain standards”. Some people living at the home said that the staff were very kind to them, but they were busy sometimes and didn’t have time to talk to them. The manager has provided information about the training, names of staff and dates of events, which has been given to staff over the last twelve months. This was given as supporting information with the annual quality assurance assessment. The information was checked when talking to the staff, and also whilst looking at the three staff files that were read in detail as a sample of these records. The Registered Manager provided evidence that the home follows the “Skills for Care” guidance and that new staff follow the common induction standards (Adults England). We saw four completed induction forms with certificates of completion. The induction notes were clear and gave proof of forward planning for further training. We also saw that the manager had ensured that staff appraisals had been carried out, and recorded. The home also provides the staff with their own copy of the “staff handbook”. This includes information about their terms and conditions of employment, health and safety, the induction into the home and the expectations of their conduct. The three staff records that were read in detail showed that the home has followed its recruitment procedures on the latest person to begin work at the home. There was proof of identity, references and a completed interview form. A POVA first had been obtained and the Criminal Records Bureau check applied for form a major service provider. There was also proof that the induction procedure had commenced. The other two records were of staff who had worked at the home for some time. They were complete with a full record of the training that had been undertaken in this employment. The home had evidence that it does retain staff with several staff who have worked in it for a long time. The people who completed the Commission for Social Care Inspection service users survey forms said that the staff were good. Some comments were, “The staff are wonderful”, and, “Senior staff are excellent, younger ones vary”. Relatives said, “We are very satisfied with the standard of care our relative receives” and, “At busy times the staff seem to be stretched but they always are polite and well mannered to my relative. She often praises them”. Another said, “I praise the Matron and all the staff at the care home for the love, care and attention that my relative receives keeping her happy everyday”. Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 24 One third of the care staff have a National Vocational Qualification at level 2 or above in care. One third of the staff are presently working towards the National Vocational Qualification level 2 in care. Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 25 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): The homes performance was assessed against Standards 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Registered Managers clinical skills are good and she directs good care for the people who live in the home. The Registered Managers general business management skills need to improve so that the performance of the whole service, including its communication and relationship with others, benefits the people who live in the home. Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 26 EVIDENCE: The Registered Manager is a degree level Registered Nurse and she has a qualification in management. She has worked hard to address the requirements and recommendations made at the last key inspection. We found that she had had many successes in fulfilling the requirements. There were some areas that still required her attention that have been made evident in the body of this report. We found that she has good clinical skills but that in her enthusiasm to meet the needs of the people she cares for she does act impulsively and does cause other health care professionals to question her actions. We experienced her general management style and skills on the first day of the inspection and felt that they are not as good as her clinical knowledge and skills. Her style of management has been questioned during this inspection and the effect that it had on the presentation of the home and how it reflects on the relationship with external providers of services to the people who live there. There was also a reluctance to delegate tasks to others who do have the experience to manage some of the work that the Registered Manager undertakes herself. She would then benefit from better time management and separating the roles of clinical and business management. This was discussed also with the Provider on the third day of the inspection. There have been some quality assurance exercises looking at the homes performance. They have included gaining the views of the people who live in the home through the use of questionnaires. The information that was gained was displayed in a pie chart format on the notice board. The manager has plans to extend the use of questionnaires to gain information about how people view the service. We have suggested that quality checks on the premises could be another way of monitoring the whole service. The home does not manage the affairs of any of the people living at the home. However, the Provider is now the appointee for four people who have no friend, relative, or advocate who is willing to be responsible for the collection of their pension. There are clear records that account for the pension that is collected. The home does not charge the people for this service. The home now has a copy of the Commission for Social Care Inspection publication called, “In safe keeping, Supporting people who use regulated care services with their finances”. The Registered Manager has ensured that the staff receive training appropriate to the job that they are expected to do. Where equipment is used the manager has made suitable arrangements for it to be serviced as required by legislation. She has also had competent people maintain the fire systems in the home and provided fire training for the staff. We did however find a few issues that needed attention such as the safe storage of cleaning chemicals, poorly cleaned commode that may have created an infection control issue, and a window above ground floor that was not restricted. The quality assurance Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 27 procedure suggested for the premises might have prevented these issues occurring. The annual quality assurance assessment provided by the manager for us did provide information about the dates of maintenance of equipment in the home. We checked a sample group of the dates given and found them to be correct. We also checked the accident book and how information was used by reading some people’s files who had had an entry in the book. Information was good in this respect. Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 28 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X 3 X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Warberries Nursing Home DS0000059901.V343445.R01.S.doc Version 5.2 Page 29 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 OP26 Regulation 13(4) Timescale for action The registered person must 08/08/07 ensure that unnecessary risks to the health of service users are identified and so far as possible eliminated. The home should store cleaning chemicals out of sight when not in use. Service users plans must 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 written in a clear format that can be understood by the people who are to use them. 01/11/07 Requirement 2. OP7 15 3. OP31 10(1) The registered person and the 01/11/07 registered manager shall, 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 Registered Managers business Management DS0000059901.V343445.R01.S.doc Version 5.2 Page 30 Warberries Nursing Home skills being less than her clinical skills. 4. OP19 23 (2) (b)(d) To ensure the premises is of 01/11/07 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. This relates to managing some ongoing building work and general redecoration of the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP26 OP8 Good Practice Recommendations Cleaning activities should include equipment such as commodes to prevent the spread of infection. To ensure that people who use this service have access to health care services to meet their assessed needs, the manager should improve her professional relationship and professional communication with other health and social care professionals. Staff should record the level of involvement each person in the home has during activities, even the very frail people who might only be reacting at a sensory level to the activities that happen around them. It is recommended that Registered Manager extends the quality assurance and quality-monitoring systems to include a regular review of the premises, décor, maintenance and Health & Safety check. This should help DS0000059901.V343445.R01.S.doc Version 5.2 Page 31 3. OP12 4. OP33 Warberries Nursing Home in early identification that the clutter experienced during the inspection is appearing and take action to deal with it. 5. 6. 7. OP9 OP28 OP27 Maintain a watchful eye on the expiry dates of dressings, including those in the first aid boxes. Continue to encourage care staff to achieve their National Vocational Qualification at level 2 in care. The Registered Manager should monitor the effectiveness of staffing levels during weekends. Warberries Nursing Home DS0000059901.V343445.R01.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. 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