Inspection on 30/06/08 for Ward House Nursing Home

This inspection was carried out on 30th June 2008.

CSCI found this care home to be providing an Adequate service.

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 20/11/07

Ward House Nursing Home 12/07/06

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 28/09/2008.

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 Mark Sims Unannounced Inspection 30th June 2008 11:30 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.V365623.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.V365623.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 01983 854410 matron.whl@btconnect.com 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 Susan Doris Davies 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.V365623.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. Date of last inspection Brief Description of the Service: Ward House is a registered care home providing personal and nursing care for up to twenty-three older people. The home has been converted from two older terraced properties to make one home. Accommodation is provided in thirteen single and five twin rooms, some with en-suite facilities. The home provides pleasant and comfortable communal space and has an enclosed rear garden with extensive sea views. There is outdoor seating for residents to enjoy the garden and sea views in the warmer months of the year. Limited car parking space is available at the front of the home. The building is accessible and there is a passenger lift for residents to access the upper floors. Current fees are £100 per day for a single room and £95.00 per day for a double or shared room. The home was purchased by the current owners, Ward House Limited, in November 2005. The home is managed by the registered manager, Mrs Susan Davies. Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was, a ‘Key Inspection’, which is part of the regulatory programme that measures services against core National Minimum Standards. The fieldwork visit to the site of the home was conducted over two days, where in addition to any paperwork that required reviewing we (the Commission for Social Care Inspection) met service users, staff and management. The inspection process involved pre fieldwork activity, gathering information from a variety of sources, surveys, the Commission’s database and the Annual Quality Assurance Assessment information provided by the service provider/manager. The response to the Commissions surveys was good with eight service user and four staff surveys returned prior to the report being drafted. What the service does well: What has improved since the last inspection? The service tell us via the AQAA that they have made the following improvements to the service: ‘Produced additional documentation for the purpose of quality assurance, Revised staff training during the induction period, Purchased additional equipment for the home, Renovated and redecorated key areas within the home and Increased flexibility of staff shift patterns’. Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Ward House Nursing Home DS0000065874.V365623.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.V365623.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. EVIDENCE: The service tells us, via their AQAA that they: ‘Meet every potential service user in person to complete a comprehensive assessment of needs, Provide written information relating to the home, Encourage potential service users and their significant others to view the home before a decision is made, Undertake a second assessment if necessary, to ensure that their needs can be fully met’. The assessments of three people, admitted to the home, were reviewed during the fieldwork visit, with their care plans found to contain both professional Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 9 summaries of care and details of the in-house assessments completed by the manager or her deputy. The assessment tool is based on the ‘Activities of Daily Living’ (ADL) model of care, which provides a good indication of the persons’ abilities and support needs measured against physical and emotional health care criteria. The review of four care plans established that clear links exist between the assessment tool and the plans produced, as the latter are also based upon a modified ADL programme. The care records also contained contact sheets, which are completed when a person first approaches the service about a vacancy, this information is used to make an initial determination about the persons’ suitability and the home’s ability to meet their care needs. The manager also produced copies of the leaflet and/or brochure documentation she or the deputy take with them on pre-admission assessments and which are provided to all prospective clients’. The brochure contains basic information about the service, such as the number of places offered, visiting, etc. The home does not provide an intermediate care service and so this standard is not applicable. Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 10 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): Standards 7, 8, 9 and 10: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are not effectively put into practice. EVIDENCE: The service tells us, via their AQAA that they: ‘Implement comprehensive service users plans of care, with an emphasis on individuality, risk assessment, privacy, dignity and choice, which are reviewed monthly. Maintain close professional links with GP services, in order to obtain prompt advice/treatment, to meet service users health needs and also for review of medication. Liaise with other health care professionals to achieve a holistic approach to meeting the service users’ health needs. e.g. speech therapist, physiotherapist Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 11 and chiropodist etc. Ensure that during induction and completion of the Common Induction Standards, care staff are made fully aware of the values relating to the National Minimum standards. Provide ongoing support to service users, their significant others and less experienced staff during the dying process. Ensure that staff have a working knowledge of the Mental Capacity Act and the role of advocacy’. The service users tell us via the surveys that they generally receive the care and support they require, with four people ticking ‘always’, three ‘usually’ and one ‘sometimes’, in response to the question: ‘do you receive the care and support you need’. One person adding: ‘the staff do their best’. Four ‘service user plans’ were reviewed during the fieldwork visits and found to contain a variety of assessment tool, including: dependency assessments, nutritional assessments, moving and handling assessments, waterlow scores, bed rail consent forms, likes and dislikes profiles, social histories and if required body maps and wound charts. The care plans and the pre-admission assessments, which are the working documents, were both based on the ‘Activities of Daily Living’ (ADL) a model of care used within the nursing profession, as discussed before. An area of the home’s care planning process that could be further developed is the risk assessment documentation, which currently uses a generic model to assess, document and manage potential risks to people, instead of a person specific or centred model, which would look at the individual’s specific support needs and produce personal plans to manage any risks faced by them. An example being the use of bedrails, which for the home is a straightforward matter of assessing the suitability of the equipment to be used and gaining consent from a family member. However, people differ in height, weight, shape, size, ability to move, etc and these factors are not taken into account when producing a risk assessment, which should be a person specific document. The care plans also contain information relating the visits undertaken by health and social care professionals, these records documenting the service users involvement with professional service/agencies. Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 12 People’s files also contain copies of correspondence from professional health and social care services, which confirmed outcomes of clinic visits or appointments, etc. One person’s plan also contained a record or review of their incontinence, which is used by the community nursing service to evaluate a person’s continence habits/needs and thus provide appropriate aids. The residents’ surveys indicate that people feel they are being appropriately supported when accessing health care services, all eight people ticking ‘always’ in response to the question: ‘ do you receive the medical support you need’. The home also state via their brochure that: ‘The home has a specific service contract with Ventnor Medical Centre to provide tailored service to the home. The home has also arranged for regular visits from the hairdresser and podiatrist to attend to residents’ needs’ (the chiropody visits more relevant to this section of the report than the hairdressers’). During the tour of the premise it was established that the home does not possess a quiet lounge, where private consultations/meetings can be conducted, however, the manager did point out that a quiet area off the dining room has been created and this can be used to entertain visiting professionals if required. The home has a ‘Residents Charter’, which forms part of the home’s ‘Statement of Purpose’ document and which is on display in the entrance hallway of the home. The charter contains a long list of statements about people’s rights, etc, which the home aspire to maintain. The first three statements making clear that people should be encouraged to ‘maintain a high quality of life, with respect for individuality, maintain independence, choosing whenever possible, their own level of freedom, habits and lifestyle and to have interests dealt with confidentially and privacy respected’. However, during the tour of the premise it was noted that people’s right to privacy, respect and dignity were not being upheld in accordance with the home’s charter, as several people’s bedrooms’ were noted to be being used as storage areas for their incontinence product, which were on display. Issues of such a personal and sensitive nature, should be treated with a great deal of sensitivity and consideration and incontinence produce stored appropriately and provided to the resident either as they demand or when being supported by the care staff. In conversation with staff the reason behind these products being left in people’s rooms on display, was attributed to a lack of storage, the manager Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 13 stating that the new gel permeable pads supplied cannot be stored in the cellar, as the area is damp and the dampness is being absorbed by the pads before they can be used by the clients’. The tour of the premise established that both single and shared occupancy rooms are provided at the home, with the shared rooms fitted with curtains or screening, which can be used during the delivery of personal care. Communal facilities, toilets and bathrooms, are fitted with locks that were of a suitable design given some of the physical and cognitive impairments suffered by the residents, however, again due to the lack of storage a number of these areas are cluttered with trolley’s and toiletries, etc, which limit the available communal areas and effects choice. The residents preferred term of address was also document on their ‘service user plan’ and the interaction between the staff and the residents and the staff and the visitors noted to be appropriate and respectful. The home states via the dataset (this document forming part of the AQAA literature) that it has: ‘a comprehensive procedure for the administration of medicines and these are well adhered to’. A tour of the home medication storage area established that all medications are correctly held and secured. The medication administration record (mar sheets), are now being well maintained and completed, mistakes had recently been made when completing the medication record of a client who was the subject of a safeguarding investigation, the staff signing to state they had administered medicine, when the client was in hosptial. Records of the supervision records for staff involved in this investigation document that their practice, in relation to medication administration, is being or has been monitored, prior to them re-commencing independent medication administration. Ward House Nursing Home DS0000065874.V365623.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): Standards 12, 13, 14 and 15: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are generally able to make choices about their lifestyle, and are supported to develop their life skills. Social, educational, cultural and recreational activities could be improved to better meet individual’s expectations. EVIDENCE: The service state, via the AQAA that they: ‘Support service users to maintain contact with their significant others, according to their choice/wishes, Promote meal times as an opportunity for socialisation, inviting service users friends or family members to join them if so desired, especially on memorable dates e.g. birthdays, Provide seasonal menus with flexibility and seeking service users views on their satisfaction, Ensure that routines of daily living are adapted to meet with service users outside activities, so that they can continue to enjoy outside stimulation, whilst feeling a valued member of society, Maintain service users plans of care to promote and record their personal choices, Ensure that religious needs are met according to the service users preference, Provide activities within the home to stimulate service users according to their personal Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 15 preferences’. The care plans reviewed during the fieldwork visit contained both a social histories and a plan for socialisation, which forms part of the ADL model of care. In discussion with the manager it was established that the home does not employ an activities co-ordinator and no single person is responsible for arranging or delivering activities or entertainments in-house. The home does arrange for external entertainers to visit the home weekly and a schedule on display in the hallway evidences that Independent Arts visit monthly. There programme for the forthcoming month including: 01/07/08: 15:00hrs for 90 minutes, reminiscence/discussion. 09/07/08: 11:00hrs for 1 hour of music. 15/07/08: 15:00hrs for 90 minutes reminiscence/discussion. 23/07/08: 11:00hr for 1 hour of music. 29/07/08: 15:00hrs for 90 minutes reminiscence/discussion. It was confirmed with the manager that apart from the items that appear on this schedule no further planned activities are provided at the home and that the plan above is repeated each month, with little or no variation. On reading through the ‘Residents Charter’ it is stated that people should ‘be encouraged to fulfil human, emotional and social needs’ and ‘to be encouraged to participate in recreational activities if the individual so desires and be given the opportunity to develop new hobbies and pastimes’. Out of the eight service users to complete the surveys not one person ticked the box ‘always’ in response to the question: ‘are there activities arranged by the home that you can take part in’, with three people ticking ‘usually’, four ‘sometimes’ and one person indicating ‘never’. During the fieldwork visits no activities or entertainments were seen being undertaken with the residents. As part of the AQAA document the manager identifies herself that the home could: ‘Provide greater and more varied opportunities for service users to be stimulated. This applies particularly to those who are either bed fast or who have severe dementia’. The leaflet or brochure document, which is provided to all prospective clients’ during the pre-admission assessment process, contains information about the home’s initial visiting policy: ‘we encourage families and friends to visit and stay with you whilst you settle into your new home’, whilst the homes terms and condition document provides fuller details of the home’s visiting Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 16 arrangements: ‘Whilst visiting times are open the most convenient times are between 11 am and 7 pm each day, avoiding meal times where possible. Whilst visiting if you wish to talk privately, staff will be pleased to arrange this’. During the fieldwork visit we (The Commission) had the opportunity to speak with one service user’s relative, who stated they visited the home on a daily basis to support their next-of-kin with their meal and to spend time providing some social support and stimulation. Other visitors were also observed around the home one person coming to the office to discuss with the manager an issue to do with the arrangements for transport for their relative. The home’s ‘Residents Charter’, also states that people have the right: ‘to choose to receive or refuse visitors at any time’. The benefits or worth of the home’s ‘Residents Charter’, however, has to be questioned with the evidence indicating that people are not being appropriately supported to exercise choice or control over their day-to-day lives. For example: limited and/or repetitive social stimulation, bedrooms being used to store incontinence products, bathrooms and toilets, which cannot be accessed easily due to the equipment stored within them. There are also no resident’s meetings, according to the manager, which limits people’s ability to comment on the service provided and/or any aspects of the service they feel could be improved. The AQAA does indicate that following our (The Commissions’), last visit to the home surveys have now been introduced into the home’s quality auditing programme, however, this visit occurred too early to confirm that this process is being used effectively and so this issue will requiring at a later visit. The residents’ surveys indicate that the meals provided at the home are popular with all eight people ticking ‘always’, in response to the question: ‘do you like the meals at the home’. The main mealtime of the day was observed during the first fieldwork visit. The dining room is not large but it was noted that spaces were still available, as some people remain in their bedrooms to eat or be assisted to eat their meals. The daily menu is advertised on a chalkboard in the main lounge area of the home, the manager explaining that this helps remind people of the meals available. Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 17 The food storage facilities were appropriate and provided sufficient dry, cold and frozen food stores and there was a range of catering and/food items available. Records indicate that all staff involved in preparing food for the service users, have completed appropriate food hygiene training. The menus operate on a four weekly rotational basis and contain a choice of main meals and/or alternatives should people prefer. Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 18 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): Standards 16 and 18: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure. The homes’ approach to managing protection concerns lacks coherence and people’s safety and wellbeing cannot be assured. EVIDENCE: The service tells us via the AQAA that they: ‘Encourage discussion of any concerns between staff, service users and their significant others, ensuring that the complaints procedure is fully understood. Ensure that at staff induction and during completion of the Common Induction Standards for carers, an emphasis is placed on service users rights, as well as the home policies relating to whistle blowing and abuse. Ensure that new staff do not commence employment until all relevant checks have been undertaken in regard to references, Criminal Record Bureau (CRB) and Protection Of Vulnerable Adults (POVA). Encourage staff to liaise openly with external bodies if an incident occurs’. They also stated, via the AQAA that they can evidence the above statements through: ‘A copy of the complaints procedure is clearly displayed in the entrance hall of the home. Quality Assurance and Customer Satisfaction Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 19 Surveys. Policies relating to ‘Whistle Blowing and Abuse’ in the homes policies files. Safeguarding Adults’ flow chart displayed in the nursing office’. During the fieldwork visit it was established that some of the above statements were accurate, a copy of the home’s complaints procedure is accessible to people within the main entrance hall, safeguarding policies and procedures are contained within the home’s policy files, staff recruitment procedures are being thoroughly implemented and induction training is based on the ‘Common Induction Standards’ recommend by ‘Skills for Care’, the Skills Council for social care training and development. The service user’ surveys indicate that people are generally aware of whom to speak to if they are unhappy about any element of their care, with all eight people ticking ‘yes’ in response to the question: ‘do you know how to make a complaint’. The four staff surveys returned also indicate that they are aware of how to use the home’s complaints process, with all four ticking ‘yes’ in response to the question: ‘do you know what to do if a service user, relative, advocate or friend has a concern about the home. The dataset, which forms part of the AQAA documentation, establishes the existence of the home’s complaints and concerns procedure and that this was last reviewed in the April of 2008. The dataset also contains information about the home’s complaints activity over the last twelve months: No of complaints: 0. No of complaints upheld 0. Percentage of complaints responded to within 28 days: N/A. No of complaints pending an outcome: 0. As mentioned previously in the report the home has been the subject of a recent safeguarding investigation. The full details of this investigation cannot be shared in this report, however, the home and/or staff employed at Ward House were considered to have entered into poor practices and not to have adhered to or followed the locally agreed safeguarding protocols. As a result of the outcome of this investigation the manager has acted swiftly to ensure all staff, including the home’s management are retrained in safeguarding practices, the first of four available sessions commencing during the first fieldwork visit day. Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 20 In discussion with the manager it was pointed out that whilst she and her deputy needed and/or should complete the safeguarding training being provided, she should also consider her wider role within the home and the position she holds as the manager, which will require her to provide leadership to other staff. It was recommended therefore that she consider whether she and the deputy manager should seek additional training on top of this course, which would provide more in-depth knowledge of safeguarding practices. The homes tells us, via their AQAA and dataset, that policies on the protection of service users are in place, ‘Safeguarding adults and the prevention of abuse’ and ‘Disclosure of abuse and bad practice’, both policies updated/reviewed in the April of 2008. The dataset also establishes that over the last twelve months two safeguarding referrals have been made to the Local Authority, a statement partially support by a review of our database, which established that one alert had been brought to the Commission’s attention by the home, the second and more recent concern being reported by the Local Authority and not the home. Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 21 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): Standard 19 and 26: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, however, the lack of suitable storage is restricting access to some areas of the home and impeding people’s rights. EVIDENCE: The manager states via the AQAA that: ‘Ensure that the home appears friendly and welcoming at all times. Ensure that the home is free from unpleasant odours. Promote an ongoing programme of redecoration in consultation with the service users. Promote safety within the home by ensuring that recommendations made regarding fire safety are complied with. Purchase specialist equipment when required in order to promote the well being of Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 22 service users. Ensure that service users rooms are maintained at a temperature that is comfortable for them. Ensure that hand hygiene is promoted in both staff and visitors to the home. Ensure that foul laundry is dealt with in such a way as to prevent the spread of infection. All staff adhere to our policies on infection control’. The tour of the premise confirmed much of the information provided via the AQAA, with the maintenance-person noted tending the garden during one visit and repairing a serviced users’ bed on another. Two recently redecorated bedrooms were visited during the tour of the premise and the manager produced a record of the maintenance or refurbishment works that had taken place at the home for the last four years, which lists things like: ‘floor in kitchen replaced, new water boiler and filter replaced, two new pressure relieving mattress purchased, vanity unit, carpet and furniture for newly redecorated bedroom (April 2008). The maintenance-person is employed on a fulltime basis and a logging system, for jobs identified by the staff on a day-to-day basis is retained within the treatment room, where the maintenance-person signs off the jobs as completed. The maintenance-person also has a programme of routine maintenance work, which is completed on a day-to-day, week-to-week basis and this includes checking fire alarms, emergency lights, etc. Many of the bedrooms visited during the tour of the premise, contained items of an individual nature, pictures, ornaments, pieces of furniture, etc, which had been used by the occupant to personalise their room. However, as discussed previously the home’s lack of storage space is a concern, as people’s bedrooms and/or the communal facilities are being used to store equipment or aids required in the delivery of care. This problem will require addressing by the manager. The home employs domestic and General Assistant staff, who were observed during the visit undertaking their duties, which includes the laundry. Feedback provided by the staff indicate that due to the changing needs of the clients’ more of the General Assistant’s time is being taken up supporting the catering staff and therefore less on the laundry, although this was not witnessed during the fieldwork visit, when the laundry was observed being done. Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 23 The staff are also concerned that people should go from doing the laundry to assisting in the kitchen and feel a dedicate laundry person would be the solution to the problem. The home was noted to be free from odours and very clean and tidy throughout both fieldwork visit days. Information taken from the residents’ surveys indicates that all eight people feel the home is: ‘clean and fresh’ throughout, with additional comments like: ‘nothing wrong with the cleanliness’ and ‘ a great deal of trouble is taken over the cleanliness’, made. Communal toilets and bathrooms were noted to contain liquid soaps, papertowels and bins for the disposal of waste. All chemicals were stored in accordance with the ‘Control Of Substances Hazardous to Health’ (COSHH) regulations. Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 24 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): Standards 27, 28, 29 and 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and provided in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. EVIDENCE: The service states, via the AQAA that they: ‘Ensure that the allocation of care staff during the shift, provides the best skill mix to meet the service users needs. Actively encourage care staff that do not have a National Vocational Qualification (NVQ) to undertake training. Ensure that all new members of staff only commence employment once the relevant checks have been made. Provide comprehensive induction training for all new staff, along with documentation relating to their role, responsibilities and the homes policies / procedures. Monitor the effectiveness of the induction training provided for carers with a questionnaire. Monitor the effectiveness of the induction training for qualified staff through supervision’. Copies of the home’s duty roster were seen during the fieldwork visit and these indicated that sufficient nursing staff, care staff, catering staff and general assistants were on duty to meet the needs of the residents’. Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 25 Sufficient staff were also observed around the home during the visit, with this most noticeable during lunchtime, when staff were available to help people in the dining room, main lounge and in taking meals to people who decide or are confined to their bedrooms due to poor health, etc. Feedback from the staff, via the surveys, is a little inconsistent with two staff indicating that there are ‘usually sufficient staff on duty to meets the needs of the clients’, whilst two other staff indicated that there are ‘never’ sufficient staff. However, the comments of the staff who felt there were ‘never’ enough staff on duty appear to be referring to catering and general assistance and not directly to care staff, comments like: ‘I feel the home would greatly benefit from a laundry person’, made to support the comments. The information provided by the service users indicates that staff are generally available when required, four people ticking ‘always’, two ‘usually’ and two ‘sometimes’ in response to the question: ‘are the staff available when you need them’. During the fieldwork visits the manager provided evidence, by way of a computerised programme, of the training matrix being introduced into the home, which she plans to have operational within the next six months. Presently the manager uses a paper based training record to document the training completed by staff, this document providing information on both the training completed and the dates by which training courses should be updated. Over the last twelve months the, records indicate, that staff have completed a variety of courses including those deemed mandatory by the management: moving and handling, fire safety, first aid and more specialised courses: venepuncture, syringe drivers, Mental Capacity Act, Challenging Behaviour and most recently the Safeguarding training. The evidence to support that the manager uses the system to ensure updates are completed in a timely fashion, is best demonstrated by one of the catering staffs records, which indicated that they had last completed food hygiene training in February 2005 and that it was updated in the February of 2008, within three years of completing the original course. The manager was also able to demonstrate that training is on-going with records available, which confirmed dates for further safeguarding training, infection control training and dementia training, the latter via a distance learning process. Information taken from the dataset and confirmed with the manager, indicates` that currently the home employs twelve care staff. Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 26 Five of the twelve staff has completed a National Vocational Qualification (NVQ) at level 2 or above and this provides the home with a rate of 33 of its care staff possessing an NVQ at level 2 or above. The dataset also indicates that four care staff are completing their NVQ, which could increase the percentage of staff holding an NVQ level 2 or equivalent to 75 . Information contained within the dataset establishes that a recruitment and selection strategy/procedure exists to support the manager when employing new staff. It also indicates that all of the people who worked in the home over the last twelve months have undergone satisfactory pre-employment checks. On reviewing the files of three staff all of the required checks were in place, Criminal Records Bureau (CRB) checks, Protection Of Vulnerable Adults (POVA) checks and two references. The files also contained completed application forms, health declarations, photographs of the employee, interview summaries, personal information and information used to support the CRB application process. Feedback provided by the staff, through the surveys, establishes that they feel they completed a thorough recruitment process and that the employer ‘carried out checks, such as your CRB and references, before they started work’. Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 27 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): Standards 31, 33, 35 and 38: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management and administration of the home may be based on openness and respect and a quality assurance system in place but there are areas in which the management team does lacked competence and experience. EVIDENCE: The service states, via the AQAA that they: ‘Maintain the competence of the registered manager through a process of regular training. Encourage an atmosphere where the staff feel valued. Ensure that the opinions of service users are incorporated into the day-to-day running of the home. Liaise with those responsible for maintaining the financial interests of the service users. Ensure that care staff undergo formal supervision at least six times a year. Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 28 Ensure that new care staff receive training with regards to safe working practices during their induction. Risk assessments are undertaken as hazards are identified, and more formally, on a yearly basis’. At previous inspections and during the fit persons’ process, which tests a persons’ fitness for registration, under the Care Standards Act 2000, it has been established that the manager is Qualified Nurse and that she possess the ‘Registered Managers Award’ qualification. However, the recent safeguarding investigation and the subsequent disciplinary process, which was overseen by the manager, with support from the provider, has established serious gaps in the managers’ knowledge base, which lead to errors being made when initially handling the safeguarding referral and latterly conducting an internal investigation and hearing for the staff involved. The manager initially failed to report, in accordance with locally agreed protocols and the Care Home’s Regulations, Regulation 37; an event that affected the wellbeing of a client. The manager then compounded this error by initiating an internal investigation, which was not thorough, robust or properly structured. When the issue was finally investigated by the Local Authority and a conclusion reached, which identified poor practice on the part of the staff involved, the manager failed to conduct an appropriate or adequate internal investigation, in accordance with the home’s disciplinary process, this was evidenced during a review of the minutes of the meetings with staff. In a conversation with the manager she confirmed that she did not have any experience of disciplinary processes and that she had no resources other than the organisation to refer to on how the process should be managed. She stated that the organisation has never arranged training for her around this aspect of employment management and that they do not have a contract with any employment management company. The manager has acted quickly, in arranging for safeguarding training to be provided, to improve her knowledge on safeguarding matters and more specifically the Local protocols and Regulation 37 process. However, her lack of knowledge, when it comes to managing a robust disciplinary process, can only be addressed by the organisation, which must seek to provide the manager with the necessary skills and resources to ensure all aspect of her role can be effectively discharged. The manager, as indicated above, has introduced a series of questionnaires for use with the home’s quality assurance process. It is difficult at this time to Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 29 state how effective the introduction of this system will be, as the previous visit to the home only took place in the November of 2007. This aspect of the home’s service will require revisiting to establish how effective the questionnaires are in providing people with an opportunity to comment on the care delivered at the home. It was stated by the manager during the fieldwork visit that residents’ meeting are not provided at the home. Care plans and risk assessment documents are being reviewed and updated accordingly and other records, like those relating to the maintenance of the environment and the training and development records, provide evidence of quality assurance being completed, although not involving the service users directly. Records of staff supervisions’ were seen during the fieldwork visits and staff are asked to comment on the outcomes of their induction training, etc, which provides information on the effectiveness of the process. Staff meetings are also arranged, although the indication is that these are not formally planned/scheduled in advance and that they are arranged on an as and when basis. The organisation are now arranging for visits to the home to be undertaken in accordance with Regulation 26 of the Care Home’s Regulations and reports sent to the home to document the outcome of these visits. 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. Health and safety training is being made available to staff, with the training record providing evidence of the courses attended and those to be attended by staff, including: infection control, first aid and moving and handling, etc. The tour of the premise identified no immediate health and safety issues, and the environmental risk assessments do consider both potential areas of harm and how these can be managed. The service tells us, via the dataset that health and safety policies and procedures are made available to the staff and that domestic appliances and personal equipment is regularly maintained and serviced. Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 30 Generally the service users and their relatives are satisfied with the service being provided at the home and raised no concerns in relation to either Health or Safety issues. Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 31 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 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 1 X 3 X 3 X X 3 Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation Requirement Timescale for action 11/08/08 2. OP10 3. OP12 4. OP19 5. OP31 Regulation The manager must review the 13 home’s risk assessment process to ensuring that risks and plans to manage those risks are individually assessed and managed. Regulation The manager must ensure that 12 people’s privacy and dignity are respected at all times and that aids or equipment required in the delivery of personal care are appropriately stored and not left on display in people’s bedrooms’. Regulation The manager must review the 12 home’s entertainment and approach to social stimulation for service users, ensuring it is varied and meets their assessed/identified needs. Regulation The manager must consider how 23 she can improve/increase the home’s current storage capacity to ensure items are not inappropriately stored in communal facilities and/or clients’ bedrooms. Regulation The organisation must consider 10 how they are to support the manager in developing DS0000065874.V365623.R01.S.doc 11/09/08 11/09/08 11/09/08 11/09/08 Ward House Nursing Home Version 5.2 Page 33 awareness, knowledge and experience of how to manage and/or operate a robust disciplinary process. 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 OP18 Good Practice Recommendations The manager should ensure the safeguarding training being delivered at the home is sufficiently in-depth to meet her and her deputies needs. Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ward House Nursing Home DS0000065874.V365623.R01.S.doc Version 5.2 Page 35 - 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. 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