Inspecting for better lives Random inspection report
Care homes for older people
Name: Address: Ward House Nursing Home Ward House Nursing Home 21 - 23 Alpine Road Ventnor Isle Of Wight PO38 1BT one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Mick Gough Date: 0 4 0 3 2 0 0 9 Information about the care home
Name of care home: Address: Ward House Nursing Home Ward House Nursing Home 21 - 23 Alpine Road Ventnor Isle Of Wight PO38 1BT 01983854122 01983854410 matron.whl@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ward House Limited care home 23 Number of places (if applicable): Under 65 Over 65 4 0 23 0 8 dementia dementia old age, not falling within any other category physical disability physical disability Conditions of registration: 0 23 0 23 0 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category: Physical disability (PD) Dementia (DE) old age, not falling within any other category (OP) The maximum number of service users to be accommodated is 23 Date of last inspection Care Homes for Older People Page 2 of 11 Brief description of the care home 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. At the last key inspection fees were 100 pounds per day for a single room and 95.00 pounds per day for a double or shared room. Full details of current fees are available from the home 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. Care Homes for Older People Page 3 of 11 What we found:
We undertook an unannounced visit to follow up on the previous key inspection where a number of requirements had been made. We looked at three care records of people accommodated that included the records of one service user who had been admitted since the last visit. The other care record related to the management of a service user who had developed pressure ulcer and we looked at how the home was managing this issue. One service user had been admitted out of county and the home had obtained detailed assessment from her care manager and had also completed their own assessment in order to ensure that this persons needs could be met. We found that the assessment contained good information including a life history, moving and handling assessment, social and emotional needs as well as eating and drinking. The assessment indicated that this service user had a recent history of falls and there was a risk of falling out of bed assessment recorded in care records seen, however there was no care plan to demonstrate how this risk would be managed. The manager reported that bedrails were in use in the home, we found there were no risk assessments and consents available in all three records that we looked at. The records showed and the manager confirmed that there were at least five of the service users who were receiving thickened fluids as they were at high risk of choking. Although this information was in the plan of care, there were no care plans or assessments including swallowing assessments such as SALT in place to manage these risks. There were no details of how much thickener was needed in fluids in order to inform practice and ensure that the service users received appropriate care as required. The three records we looked at contained a dietary needs assessment and identified risks as low /medium. As part of monitoring the service users dietary needs, the care plans stated that monthly weights were to be monitored. The records showed that this had not been completed since October 2008 and had recently re commenced and the manager said that she was monitoring this. The two care plans contained clear information about how the care needs of the service users would be met. One of the recent care plans was confusing and contained numbered plans to be followed, however these did not correspond to the care plans. Records showed that one of the service users did not like having a bath, however the care plan says weekly bed bath/general bath. The care records showed that people who were incontinent were provided with three pads day and night. No further information was available in relation to the type of pads used and the frequency that these needed changing to inform practice and ensuring that peoples continence problems was managed appropriately. As part of managing the risks and prevention of pressure ulcers, all the records showed that the home was using the Waterlow assessment tool and the service users Care Homes for Older People Page 4 of 11 were provided with pressure relieving mattress. We observed that the home was using different types of mattresses and these were set at different levels. There was no procedure/ information available to dictate how this judgment was made. These should include clear manufacturers guidance to ensure that they are managed safely and do not put the service users at higher risks of skin damage. We looked at the record of a service user who was receiving treatment for a pressure ulcer. A wound care plan had been developed and records of treatment was recorded. We found a large quantity of dressing in the service users bedroom. The wound care plan and the record of dressings applied differed, which showed that the staff were not following the wound care plans. There is also the risk that due to the number of different wound dressing found in the service users room the staff were using what was at hand rather than what is in the care plans. The manager reported that the home was using a bulk system for wound dressing. We were unable to ascertain how this worked in practice as there were a large number of wound dressings stored at the service. Some of these had been dispensed as prescribed with the service users names and others were loose in a box unnamed. During a walk around the home we noted that there were two wound cleansing substances in one bedroom that had been prescribed for another service user. We also found that the shared rooms contained a number of creams and ointments that were not labeled and this posed a high infection risk. We looked at the medication management that the staff undertook on behalf of the service users. All medicines were dispensed individually. The staff maintained a record of medication administered on the Medication Administration Record (MAR) charts. The staff maintained records of most of the drugs received at the service. We looked at a random sample of medication received and found that they matched the current stock as maintained at the home. There were no instructions available for as required medication in order to inform practice and to ensure that people receive their medications as prescribed. This was brought to the attention of the manager at the time of the visit and must be developed. We found that medication details that the staff transcribed onto the MAR records sheets did not contain adequate details such as date received, frequency of administration, minimum and maximum dosages. Other improvements needed is that staff should ensure that all medication transcribed has two signatures. Any medication not given/ omitted must have the appropriate code inserted in order to inform other staff practices and ensure that people receive their medication correctly and safely at all times. The manager reported that the home had introduced bulk ordering for a number of medication that included aperient, creams, ointments, analgesia and a variety of wound dressing. There were no policy and procedures in place to show how this would be managed in practice. Clear procedures must be developed if this was to be introduced to include ordering, dispensing and prescribing responsibilities. It was unclear from the list of bulk medicine whether this had been agreed and by whom, as this was not signed. Although some progress had been made regarding risk assessments the visit identified that care plans did not always provide clear information to ensure that all care needs were met. Care Homes for Older People
Page 5 of 11 We toured the home and observed staff supporting residents and staff were seen to be interacting well with residents and using their preferred form of address. Staff were seen to knock on residents doors before entering and residents spoken to confirmed that staff treat them with dignity and respect. We had the opportunity to speak with 2 visitors to the home who told us their relatives were treated very well by the staff and that privacy and dignity was maintained. As part of the tour of the home we saw residents bedrooms which had been personalised and those residents who needed incontinence products had suitable storage in their rooms, which were out of sight to protect residents privacy and dignity. We found that the requirement made at the last Key inspection regarding privacy and dignity had been met. We looked at activities provided at the home and found that the home had an activities folder which provided evidence of the activities that take place in the home and this also recorded those residents who took part, however if did not show that the residents who stayed in their rooms had been given the opportunity to take part. The manager told us in the homes completed AQAA that the home organises activities according to the service users choice and this was confirmed on the day of the visit. The activities file showed us that all of the residents at the home had completed an activities survey and this told the home what activities the residents liked to take part in. There was an activities programme on the notice board for the month of March and this included , exercises to music, reminiscence, visiting entertainers and church service. In addition to the planned activities the manager told us that they have Pat Dogs who visit the home every two weeks and there was photographs of residents enjoying the company of the animals on the homes notice board. The manager also told us that the home has purchased a portable TV with built in Video and DVD player so that if residents wished to watch a film in their room then this could be arranged for them. On the day of the visit there was a visiting entertainer who was singing in the lounge and was encouraging residents to be involved as much as possible. We observed that there were seven residents who were listening to the music, the other residents stayed in their rooms. We had the opportunity to speak with 4 of the residents in the lounge who told us that the activities were generally fine and that the amount of activities were about right. 2 of the residents who we spoke with who were in their rooms told us that they did not wish to be involved and preferred to stay in their rooms. We found that the requirement regarding activities had been met. The home sent us their completed AQAA and this told us that the home had increased the number of staff who have received training for the protection of Vulnerable Adults and that adult protection procedures were understood by staff. We checked the staff files of 4 staff members and this showed that all had completed adult protection training. We spoke to 3 members of staff who were able to demonstrate that they knew what action they should take if they had any concerns. The manager had a copy of the Isle of Wight adult protection protocols and there was a flow chart of the procedures to follow on the notice board in the office at the home. We found that the home had taken appropriate action regarding the recommendation made regarding adult protection. We spoke to the manager who told us that she had undertaken additional training regarding adult protection. She said that the home had now successfully recruited a deputy manager and that this was allowing her to delegate some duties and also allowed her to spend more time on management issues. The deputy manager has only Care Homes for Older People
Page 6 of 11 recently been recruited and we will need to follow up the management arrangements at the next inspection of the service. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set.
No. Standard Regulation Requirement Timescale for action 1 7 Regulation 13 The manager must review 11/08/2008 the homes risk assessment process to ensuring that risks and plans to manage those risks are individually assessed and managed. Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 13 Where any risk are identified, 19/04/2009 suitable risk assessments must be put in place to ensure that staff have the information they need to manage them This will ensure that staff have the information they need to manage any risks to service users 2 7 15 Care plans must be reviewed 19/04/2009 and amended to ensure that the care needs of residents are clearly identified and managed This will ensure that staff have all the information that they need to ensure the service users needs can be met. 3 7 15 The registered person must 19/04/2009 ensure that wound care plans provide staff with clear information regarding any dressing that need to be applied this will ensure staff have the information they need to Care Homes for Older People Page 9 of 11 ensure that the correct type and size of dressing is used. 4 9 13 The registered persons must 30/03/2009 ensure that accurate records are kept for the receipt, safekeeping and disposal of all medications including, dressing, creams and ointments. This is to ensure that there is an accurate audit trail of medication and will help reduce the risk of cross contamination and ensure that medication perscribed for individuals is only used for the named person. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
