Inspection on 12/07/06 for Ward House Nursing Home

This inspection was carried out on 12th July 2006.

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

Other inspections for this house

Ward House Nursing Home 23/06/09

Ward House Nursing Home 28/04/09

Ward House Nursing Home 04/03/09

Ward House Nursing Home 30/06/08

Ward House Nursing Home 20/11/07

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Winton House

Newbeech House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Ward House Nursing Home Ward House Nursing Home 21 - 23 Alpine Road Ventnor Isle Of Wight PO38 1BT Lead Inspector Janet Ktomi Unannounced Inspection 12th July 2006 10.00 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 Ward House Nursing Home DS0000065874.V294303.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. Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ward House Nursing Home Address Ward House Nursing Home 21 - 23 Alpine Road Ventnor Isle Of Wight PO38 1BT 01983 854122 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) Ward House Limited Care Home 23 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (23), of places Physical disability over 65 years of age (8) Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One person is accommodated in the (DE) category (under 65 years). This named person may continue to be accommodated. The home may accommodate up to five people aged 60 - 65 years of age within the above categories. New service Date of last inspection Brief Description of the Service: Ward House is a registered care home providing nursing care and accommodation for up to twenty-three older people, eight of whom may have a physical disability and four of whom may have dementia. Included within the twenty-three beds the home may accommodate up to five people between the ages of 60 and 65 years who have a physical disability or dementia and one person with dementia under the age of 60 years. Ward House Nursing Home consists of two older houses combined to make one home. Accommodation is provided in thirteen single and five twin rooms, some with en-suite facilities. The home provides appropriate communal space and has a pleasant enclosed rear garden with extensive sea views. Limited car parking space is available at the front of the home. The home was purchased by the current owners, Ward House Limited, in November 2005. The manager/matron is in the process of applying to the Commission for registration. Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains information gained prior to and during an unannounced visit to the home undertaken on the 12th July 2006. The inspector would like to thank the people who live at the home and the staff for their full assistance and co-operation with the unannounced visit. The visit to the home was undertaken by one inspector and lasted approximately six hours commencing at 10.00 a.m. and being completed at 4.30 p.m. All core standards and a number of additional standards were assessed. The inspector was able to spend time with the nursing and care staff on duty and was provided with free access to all areas of the home, documentation requested and service users. Prior to the visit a new service pre-inspection questionnaire was sent to the home and returned within the required time scale. External professional questionnaires were sent to people identified in the pre-inspection questionnaire as having regular contact with the home. Comment cards were returned from two GPs and three care managers. Service user and relative comment cards were sent to the home. Information was also gained from the link inspector and the home’s file containing notifications of incidents in the home. During the visit to the home the inspector was able to meet with and talk to service users and their visitors. What the service does well: Relatives and service users stated that they were very happy with the service provided at Ward House Nursing Home. They stated that they felt the home was run in the best interests of the service users and that the nursing and care staff were very friendly and helpful. Relatives stated that they would definitely recommend the home to friends or family in need of nursing care. The new providers have identified a number of areas within the home which require modernisation and have commenced a programme of improvement to facilities such as the laundry area, clean linen storage and plan further work to improve the sluice facilities on the second floor. Many of the people living at the home are very frail. Most were seen during a tour of the home and they appeared to be comfortable and appropriately cared for. Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 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. Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 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 Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 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, 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Prospective service users, or their families, are provided with the information they require to make an informed choice about where to live. Service users’ needs are fully assessed and they know that their needs will be met when they enter the home. Service users and their families are invited to visit the home prior to admission. The home does not provide an intermediate care facility therefore Standard 6 is not applicable. EVIDENCE: The inspector viewed the pre-admission assessments for three people admitted to the home in recent months and discussed the admission process with the Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 9 representatives of one service user also recently admitted to the home. The home’s admission process was also discussed with the home’s manager. All pre-admission assessments seen had been completed by the manager or deputy manager and are held within individual service users’ care plan folders. Pre-admission assessments are completed on a specific form which contains all the relevant areas required to enable the assessor to determine if the home is able to meet a potential service user’s needs. Information gained during preadmission assessments was seen to have been transferred and included on care plans formulated following admission. The inspector spoke with the representative of a service user who had been recently admitted to the home. The representative confirmed that the home’s manager had visited the prospective service user to ascertain a full picture of the nursing and care needs. The representative had visited Ward House and been provided with detailed written information about the home. The representative stated that she had felt reassured that the service user’s needs could be fully met prior to moving into the home and that since admission she had no concerns or complaints about the service. The inspector discussed the admission procedure with the manager and deputy manager who confirmed that where possible potential service users are invited to visit the home. When this is not possible their relatives or representatives are invited to visit the home. The manager stated that consideration is given to the existing service users’ needs when deciding if a new person should be admitted to the home. Discussions with nursing and care staff indicated that they have appropriate information about new admissions to enable them to care for people from the day of admission. During the unannounced visit there were two telephone calls from care managers with referrals for the home. The questions asked and the manager’s decision not to accept these referrals indicated that the home would not accept people whose needs it could not meet or whose needs were such that the impact on the staff and care of people already living at the home would be compromised. The manager was clear about the need to ensure that she had available all the necessary equipment such as pressure relieving mattresses before accepting a referral. The home has five bedrooms for twin occupation and the manager stated that the needs of the person already occupying a twin room would be paramount when deciding if a second person could be admitted to the room. The home is registered for nursing care of older people, up to eight of whom may have a physical disability and up to four of whom may have dementia. The inspector recommends the provider and manager consider requesting a variation to these numbers as most people are admitted to nursing homes for either a physical disability or dementia. Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 10 In February 2006 the home had an additional visit following re-registration as a full key inspection was not planned within that inspection cycle. It was noted at this additional visit that the home’s brochure and service users’ guide had not been updated following re-registration by the new providers. The manager confirmed that these documents have been updated to include the names of the new provider. Relatives and representatives informed the inspector that they had received appropriate written information about the home. The manager stated that she always provides a copy of the home’s brochure and service users’ guide to prospective and new service users or their relatives. Discussions with the manager and deputy manager, and documentation viewed, indicted that should a service user’s needs change following admission then the home would consult with external professionals to identify a more suitable residential placement. Letters in respect of this were seen in the file of a service user whose health and mobility has improved since being admitted to the home and who might now be more appropriately accommodated in residential care. Ward House Nursing Home DS0000065874.V294303.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. All service users have a care plan that clearly identifies health and social care needs and how these should be met. Manual handling assessment and management plans must be regularly updated to reflect changes in service users’ manual handling needs. Medication is appropriately stored. The manager must ensure that the medication administration records are fully completed. Medication records must state if a person does or does not have any known allergies. Medication may only be administered to the person for whom it has been dispensed. The home must use individual bottles for named people or stock bottles. Service users are treated with respect and their privacy is maintained at all times. Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 12 EVIDENCE: During the unannounced visit to the home a number of care plans for new and existing service users were viewed. Comment cards were sent to care managers the home identified as being in regular contact with the home. Three completed comment cards were returned. Care managers confirmed that their service users had care plans and that they were satisfied with the overall care provided to their service users placed in the home. Due to the dependency levels and communication needs of the service users it was difficult for the inspector to gauge the service users’ personal feelings about the care planning process of the home and their levels of involvement in the process. Discussions with relatives indicated that they were aware of care plans and had been involved in discussions about their relatives’ care needs and how these should be met. One service user confirmed that she had been included in care planning decisions. Care plans seen by the inspector confirmed that all service users have an individual care plan that had been reviewed every month and contained daily records of care received. Statements within care plans seen were concise and specific to enable the service users’ needs to be clearly identified and met. Care plans were seen to contain all the information required including specific risk assessments and management plans to cover pressure areas, manual handling, continence, nutrition and falls. Risk assessments had been regularly reviewed and updated. Care plans also contained information about a service user’s likes and dislikes as well as social history information (when this was available). Comment cards were sent to GPs service users living at the home are registered with. Two comment cards were returned. Both GPs stated they were happy with the care provided at the home and had no concerns or additional comments. Care plans were seen to contain information about health needs and how these should be met. The manager explained that most service users are registered with one GP who visits the home every Monday and at other times as requested. The other GP with fewer people living at the home visits as required. Records of visits from the GP and other health professionals were seen in the care plans. Discussions with qualified nurses indicated that they were aware of how to seek advice and support from the GPs and other health professionals. A chiropodist regularly visits the home with dental or optician appointments being organised as and when required for individual service users. At the time of the visit to the home a dentist was seeing a service user in the service user’s bedroom. The home has contacts with specialist nurses, learning disability, stoma and Macmillan, who provide advice and training for staff in connection with specific issues and service users. Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 13 All relatives or representatives spoken with during the visit to the home stated that they were satisfied with the overall care provided at the home. All were very complimentary of the service received and stated they would recommend the home to a relative or friend in need of nursing home care. The arrangements for the management of medication within the home were assessed. All medication is administered by qualified nurses and is stored securely within the home. Repeat prescriptions are collected monthly from the surgery and taken to the pharmacy. Medication is booked into the home by the qualified nurse on duty at the time medications arrive into the home. The medication administration records were viewed. All were seen to have photographs of the service user. The Medication Administration records were noted to have a number of gaps, where it was not clear if a prescribed medication had been administered or not. The manager must implement a system for checking that medication administration sheets are fully completed. It was also noted that although a number of service users were receiving a liquid laxative only one bottle was open and in use in the medications trolley. Additional supplies, named for individual service users were seen stored in a cupboard. These had not been opened and one service user had a quantity stored. The inspector suspected that the one bottle in use was being dispensed to all service users prescribed this medication although it was labelled with a service user’s name. The manager confirmed that this was the case. The manager must ensure that medication is only administered to the person for whom it has been dispensed and whose name is on the label. A solution to having a number of bottles would be to request the GP to prescribe a stock bottle. The medication administration records have a front sheet containing information about each service user and a photograph. The manager must ensure that the section for allergies is completed even if to state no known allergies. The arrangements for controlled medications were seen to be appropriate with the required records in place. The home has a contract with an approved waste disposal company for the removal of unused medications with the necessary specialist containers and records seen. During the visit to the home the inspector observed many instances when service users’ privacy and dignity were supported and maintained by care staff. The approach by all staff to service users was seen to be respectful and appropriate. Service users stated that staff were nice and polite and that privacy and dignity were respected and maintained. Relatives confirmed that service users are treated with respect and that dignity is maintained at all times. Care staff were observed to knock on doors before entering and not to open doors too wide to preserve privacy. Twin bedrooms were seen to be equipped with curtains as screens between beds to ensure privacy during personal care tasks. Ward House Nursing Home DS0000065874.V294303.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home provides activities and entertainment however the manager should consult with specialist dementia groups to identify if there are additional ways in which very dependant frail people with dementia may be appropriately stimulated. Visitors are welcomed at the home with service users having as much control over their lives as possible. Service users receive a wholesome, appealing balanced diet. EVIDENCE: On the day of the unannounced visit an external entertainer was at the home to sing to service users. The entertainer stated that she regularly attended the home, with a service user confirming this. Many of the people who live at the home are very frail and dependant and therefore confined to bed. Only one service user was enjoying the entertainment. The manager stated that a number of people who had previously enjoyed the entertainment had become more frail or passed away, however they continued with the sessions as the one service user really enjoyed them. Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 15 The inspector and manager discussed activities for other people living at the home. One service user was seen doing a jigsaw puzzle and informed the inspector that she liked her videos that staff would put on for her. Care plans contained social history information and likes and dislikes. The manager stated that they play jazz music in one service user’s bedroom as he had been known to like jazz music. The home operates a key-worker system and key-workers can apply to the home’s amenities fund if there are items or equipment they think service users will enjoy or be stimulated by. The home has a supply of games and reminiscence photographs however these are not suitable for the very frail service users. The manager is recommended to contact a specialist dementia group to discuss with them the problems of providing suitable activities and stimulation for the very frail and dependent people the home cares for. Throughout the unannounced visit to the home the inspector was able to meet with relatives and visitors. They all stated that they are able to visit whenever they like, some staying for lunch with their relative and others being provided with refreshments. All visitors stated that they are welcomed into the home, kept informed of any significant information about their relative and felt able to ask questions or make comments to the staff. Interactions between staff and visitors were noted to be warm and friendly. Many service users previously lived in the surrounding area with visitors stating they would recommend the home to others. The chef informed the inspector that the new owners have stated that relatives should be provided with meals free of charge if requested. The inspector was able to meet the head chef and her assistant. The kitchen is of an appropriate size with a separate wash-up area. The head chef stated that she does not have a budget for food and can spend what is required to meet service users’ individual likes and dislikes as well as special diet needs. The head chef demonstrated a commitment to providing high quality food and that seen during the visit was visually appealing and smelt pleasant. Relatives and service users stated that they liked the meals provided at the home. Appropriate records are maintained in respect of meals served at the home. The head chef showed the inspector the information sheets she is supplied with in respect of new service users which state any special dietary needs as well as likes and dislikes. The kitchen has a list of birthdays and birthday cakes are baked for all service users. Service users were seen being provided with hot and cold drinks throughout the visit to the home. Service users stated that they can request changes to the main menu and alternatives are provided at all meals. Service users also stated that they could decide where they spent their time, lounge, garden or their bedrooms and that they had choice in what they did during the day. Many of the people who live at the home are very dependant and frail, their relatives stated that they are involved in decisions about care planning and treatment. Social history and likes and dislikes information is gathered as part of the care planning process Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 16 and can help staff determine, for instance, what sort of music a person might enjoy having played in their room. Ward House Nursing Home DS0000065874.V294303.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home appropriately responds to complaints and service users are protected from abuse. EVIDENCE: Service users stated that they would inform the manager if they had any concerns or complaints but did not have any at the time of the visit to the home. Relatives confirmed that they were aware of the complaints procedure and stated that they would feel able to raise any concerns or complaints with the senior nurse or manager. Relatives had no concerns or complaints to report to the inspectors at the time of the visit to the home. Comment cards returned by care managers and GPs stated that they had not received any complaints about the service. The pre-visit questionnaire returned by the manager stated that the home had received two complaints in the preceding twelve months. One had been partially substantiated. The records for these were viewed and discussed with the manager. These indicated that staff had responded appropriately to the complaints that had been fully investigated and responded to. Following the additional visit to the home in February 2006 (following re-registration and purchase by the new providers) the manager was required to update the complaints procedure with the correct Commission for Social Care details. This was seen to have been done with a copy of the complaints procedure displayed on the hall wall. Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 18 The inspector discussed adult protection with the manager, qualified nurses and care staff on duty. They were able to identify the appropriate action they would take if they suspected that adult abuse may have occurred to one of the service users. The manager stated that adult protection is included within the home’s induction for all new staff. The home does not become involved in service users’ personal finances with additional services (hairdressing, chiropody or newspapers) being invoiced to the person responsible for the service users’ money. A sample of invoices was seen and these are clearly itemised so that people will know exactly what additional services are being charged for and how much. The recruitment procedures should prevent unsuitable people working at the home and include POVA and criminal records bureau checks. Ward House Nursing Home DS0000065874.V294303.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home is generally well maintained both internally and externally with evidence of ongoing refurbishment and redecoration work. The tour of the premises revealed a property that was clean and tidy throughout. The first floor WC must be redecorated and be provided with new floor covering. The proprietor must provide the Commission with a timetable for the replacement of all non-height adjustable beds. EVIDENCE: The inspector was shown around the home by the manager at the start of the visit. The manager informed the inspector of the changes and improvements planned and already completed since the new proprietors purchased the property in November 2005. The laundry area, located in the basement, has been improved with new washing machines and ironing equipment. Improved Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 20 storage arrangements for clean bed linen and towels has been provided on the ground floor which should ensure that fresh linen is warm when provided to service users. The staff WC on the ground floor has been modernised and redecorated. The home employs a full time maintenance man. He explained to the inspector how he is made aware of jobs that are required (work book in which staff were noted to identify small jobs) and also planned redecoration and improvement work. The maintenance man stated that he redecorates bedrooms should they become vacant and need attention. The maintenance man informed the inspector of the plans already in place to improve the sluice facilities on the second floor. The home provides pleasant communal space in a lounge, with extensive sea views and good sized dining room. There is also a staff room and additional quiet lounge where private meetings could be held. Communal rooms were pleasantly decorated and equipped with appropriate furniture. Five of the bedrooms are shared rooms. These have all been fitted with curtains to provide screening to ensure privacy during the delivery of personal care. Many of the bedrooms have good sea views and were pleasantly decorated and seen to contain personal items of their occupants. The inspector noted that many of the home’s beds are not height adjustable. Considering the high dependency care needs of the people living at the home (the manager stating that many are nursed in bed due to frailty and health needs) the proprietors must replace all non-height adjustable beds with beds whose height may be adjusted. This will ensure that staff do not place themselves at risk and also that service users are not placed at risk when being turned or receiving care. The proprietor must provide an action plan and timetable for the replacement of beds to the Commission. Other equipment appropriate to the provision of care was available at the home. Discussions with the manager indicated that she would not admit a new service user if the home did not have the necessary equipment to meet the person’s needs. Five of the single bedrooms and three of the shared bedrooms have en-suite facilities. The home has one assisted bathroom, equipped with a bath hoist and a shower room. The WC on the first floor requires attention and must be redecorated. The floor covering must also be replaced. The home has two sluice rooms, one located on the first and the other on the second floor of the home. The home already has plans to modernise and improve the second floor sluice room therefore no requirements are made in respect of this. Staff receive training in infection control and confirmed that they have adequate supplies of disposable aprons and gloves. The laundry has been provided with an industrial grade washing machine capable of washing to high temperatures for infection control. Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 21 Ward House Nursing Home DS0000065874.V294303.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home provides appropriate numbers of suitably qualified and trained staff to meet service users’ needs. Staff are appropriately recruited with all the required checks undertaken. EVIDENCE: The inspector spoke with most of the qualified nurses, carers and ancillary staff on duty during the unannounced visit to the home. Duty rotas, staff recruitment and personnel files were viewed. The inspector spoke with relatives of service users and comment cards from professionals were received prior to the home visit. Information was provided by the manager in the preinspection questionnaire. Discussions with relatives and service users indicated that they considered the levels of staffing adequate to meet care needs. Service users and relatives stated that all staff within the home were pleasant and helpful. One stating that it was more like family than staff. Interactions observed during the visit between staff and visitors/service users were warm and friendly. Duty rotas, the manager and staff confirmed that there is one qualified nurse and four care staff on duty in the mornings, one qualified and three care in the afternoon with a twilight worker commencing at 5.00 p.m. At night there is one Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 23 qualified and one care staff. The manager is not included in the above staffing numbers although can cover shifts if necessary. The deputy manager has one admin shift per week and covers shifts as the qualified nurse. The home employs a full time maintenance person, chef and housekeeping staff. Staff on duty at the time of the unannounced visit corresponded to the above numbers. Nursing and care staff stated that they had adequate time to meet people’s needs and that everyone worked together as a team. Work is allocated by the manager or trained nurse so that everyone knows who is responsible for which service users and additional tasks. The home aims not to use agency staff unless absolutely necessary. Wherever possible its own nursing and care staff are used. On the afternoon of the unannounced visit a qualified nurse was doing an additional shift to cover a shortage in care staff. The manager stating that she would rather employ her own qualified nurses to work as care staff than use unfamiliar agency staff. This means that staff caring for service users are familiar with the home and know service users’ needs. Information supplied by the manager prior to the home visit stated that the home has eleven care staff of whom six have an NVQ level two or above in care. This equates to just over 50 . The manager confirmed that she is hoping that additional staff will be undertaking NVQ level 2 although some more mature experienced care staff are reluctant to undertake this qualification. The inspector viewed the home’s recruitment files. The home has recently recruited several new staff including qualified nurses and care staff. The recruitment files were seen to contain all the information and checks that are required for all staff within the home, including evidence of Criminal Record Bureau and POVA First checks. The recruitment procedures would therefore appear appropriate to ensure unsuitable people do not work in the home. During the unannounced visit a new staff member came to the home to bring in his documentation for completion of the CRB and POVA first forms. The inspector overheard the manager explaining that the new carer could not commence work at the home until the POVA First check had been received. The manager showed the inspector the induction records held for new staff. All staff have been provided with a copy of the General Social Care Council code of conduct as well as the home’s own information booklet. New staff are required to read all policies and sign to confirm they have done so. The manager supplied details about staff training with the pre-inspection information. The information supplied indicated that the home supports staff training and that qualified nurses have opportunities to extend their skills and meet PREP requirements. Qualified nurses and care staff stated that they have opportunities for training and felt they had the necessary skills to care for the people living at the home. Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 24 Ward House Nursing Home DS0000065874.V294303.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 37 and 38 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home is run by a manager who is appropriately qualified, experienced and who is in the process of registering with the Commission. The home reviews the services it provides to ensure that the service is run in the best interests of the service users but must consider how a formal audit report may be produced. Service users’ financial interests are safeguarded. The home is generally a safe place for service users, visitors and staff. EVIDENCE: The home’s previous registered manager resigned and continues to be employed at the home as the deputy manager. The inspector spoke with her during the visit and she stated that she is enjoying her new role as she is able to spend more time with service users and ensuring care plans are maintained. Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 26 The home’s previous deputy matron is now the home’s manager. The manager is in the process of registering with the Commission and this process should be completed by September 2006. The new manager is a qualified nurse, with experience of working in nursing homes (as stated she was the deputy manager at Ward House). The manager stated that she intends to register for the Registered Manager’s Award and is aware she needs to undertake this or a similar management qualification. Qualified nurses, care and ancillary staff all stated that they felt able to approach the manager and the providers if they have any concerns or problems. Interaction observed during the visit to the home indicated that the manager and her deputy are open and available to staff, service users and visitors. The manager stated that the providers (three brothers) are frequently at the home, one supporting the maintenance person, another undertaking care shifts and the Responsible Individual making regular visits to the home. Discussions with the Responsible Individual following the visit indicated that he was aware of his responsibilities. The inspector discussed with the manager how she monitors quality of provision with in the home. The manager stated that she formally meets with relatives once a person has been in the home for about four weeks and then undertakes a formal quality assurance exercise yearly. The manager showed the inspector the forms that she sends to relatives or able service users each year. At present the home does not produce a formal quality audit report based on the results of the feedback forms. However the manager stated that any issues raised would be addressed at the time the forms are received. The manager stated she undertakes room checks to ensure cleaning is carried out correctly and meets with the chef twice a week. The chef stated that she meets with service users to discuss their food suggestions and ensure they are happy with the meals provided, this occurs on an individual basis. The new proprietors are aware that they must commence Regulation 26 visits and reports following visits should be provided to the manager and available in the home for inspection. The manager must consider how information gained from quality assurance work may be incorporated into an annual development plan for the home based on a systematic cycle of planning – action – reviewreflecting the aims and outcomes for service users. The home does not become involved in service users’ personal finances with additional services (hairdressing, chiropody or newspapers) being invoiced to the person responsible for the service user’s money. A sample of invoices was seen and these are clearly itemised so that people will know exactly what additional services are being charged for and how much. During the unannounced inspection a variety of records was inspected. These included care plans, risk assessments, Medication Administration records, staffing rotas, staff recruitment records, menus and invoices. With the Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 27 exception of the Medication Administration records that were not fully completed all records were found to be appropriately maintained and stored. All evidence indicates that the home generally provides a safe place for staff, visitors and service users. Staff receive mandatory and update training, appropriate numbers of registered nurses and care staff were on duty supported by a range of ancillary staff. The provision of all height adjustable beds would ensure that staff are able to provide care without bending and that service users nursed in bed are at the correct height for staff to care for. The home appeared generally well maintained with a planned programme of maintenance. The pre-inspection questionnaire stated that fire equipment was last serviced in May 2006 and that a visit from the fire officer has been requested as the manager was unsure when he last visited the home. The home has maintenance contracts for the lift and moving and handling equipment. Ward House Nursing Home DS0000065874.V294303.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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X 2 3 Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? New service 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 OP37 Regulation 13 (2) Requirement Timescale for action 01/08/06 2. 3. OP21 23(2)(b) 23(1)(a) OP22 4. OP33 24 (1) The manager must ensure that the medication administration records are fully completed. Medication records must state if a person does or does not have any known allergies. Medication may only be administered to the person for whom it has been dispensed. The first floor WC must be 01/10/06 redecorated and be provided with new floor covering. The provider must provide the 01/09/06 Commission with a timetable for the replacement of all non-height adjustable beds. The manager must consider how 01/09/06 information gained from quality assurance work may be incorporated into an annual development plan for the home based on a systematic cycle of planning – action – reviewreflecting the aims and outcomes for service users. Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 30 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 OP1 Good Practice Recommendations The inspector recommends the provider and manager consider requesting a variation to the numbers as most people are admitted to nursing homes for either a physical disability or dementia. The manager is recommended to contact a specialist dementia group to discuss with them the problems of providing suitable activities and stimulation for the very frail and dependent people the home cares for. 2. OP12 Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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 Ward House Nursing Home DS0000065874.V294303.R01.S.doc Version 5.2 Page 32 - 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. 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