Inspection on 17/02/06 for Wardhayes

This inspection was carried out on 17th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Wardhayes 07/08/06

Wardhayes 11/07/05

Wardhayes 23/02/05

Wardhayes 15/06/04

Wardhayes 16/03/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Wardhayes Wardhayes Simmons Way Okehampton Exeter Devon EX20 1PY Lead Inspector Helen Tworkowski Unannounced Inspection 4:15 17 February 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Wardhayes Address Wardhayes Simmons Way Okehampton Exeter Devon EX20 1PY 01837 52570 01837 55381 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) Devon County Council Kathleen Mary Westbrook Care Home 22 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (6), Old age, not falling within any other of places category (11), Physical disability (5), Physical disability over 65 years of age (5) Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Categories DE and PD for 55 years and over. No more than 5 people falling into the categories PD or PD(E) to be accommodated at any one time No more than 6 people falling into the categories DE or DE(E) to be accommodated at any one time 11th July 05 Date of last inspection Brief Description of the Service: Wardhayes is a purpose built Residential Home run by Devon County Council. The home is situated on a housing estate on the edge of Okehampton. The home has undergone considerable changes in the last few years and is currently provides the following services: “Poppy Day Centre” on the ground floor, (this service is not registered). On the first floor is a “Re-ablement Service” for five people- this service is aimed at providing short-term rehabilitation for elderly people who may have suffered a period of ill health or have recently been discharged from hospital. On the ground floor there is accommodation for six people who have dementia and who would benefit from a short stay away from home, this service is known as “The Firs”. On the ground and first floor there is accommodation for eleven elderly people, this includes two short stay beds. The accommodation is for people who are need support due to general frailty related to their age. The home has a shaft lift and when the current round of developments have been completed each area of the building will have it’s own bathing, laundry, dining and lounge facilities. There are plans to move a lounge/ diner on the ground floor to the first floor so that it is closer to the bedrooms.The home has a large kitchen that provides meals – that are taken to each dining area on heated trolleys. The home has a number of disabled access bathrooms and hoists. There is level access throughout the building.The home is staffed 24 hours a day. Each Unit has it’s own staff and assigned manager. There is a duty manager on duty in the home at all times Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection and took place between 4.15pm and 6.30pm on a Friday 17th February. The inspection included a tour of most of the building. Time was spent talking with staff and service users and in inspecting records. What the service does well: What has improved since the last inspection? What they could do better: It has been identified at numerous previous inspections that staff at Wardhayes do not have information about Service Users assessed needs before a stay. Again this was found to a concern. A good knowledge of a person’s needs is essential to ensure that their needs are met when they move. Improvements have been made to Service User plans, which detail how each person’s needs will be met. These help ensure that staff takes a consistent approach. However these improvements were not found in all Plans. Doors in the Firs Unit are alarmed or operate on a key code, and whilst this may be appropriate for the safety and well being of the individuals there was no record of any discussions about this. Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 6 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. Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Service Users can not be assured that their needs will be met as the staff at Wardhayes may not know what these are. EVIDENCE: Three Service Users files were examined during this inspection. Two files had copies of assessments, however one file had no assessment. The file with no assessment had a Care Plan that had been received from the care manager over 9 days after the person moved. Assessments are required by regulation and ensure that staff in the care home know and understand what a person’s needs are before they move. The Registered Provided is also required to write to each person prior to staying at the home and confirming that the home can meet the individual’s needs. These requirements have been made at numerous inspections however they still have not been met. Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8 Service User’s needs are met, however the documentation that helps ensure that this is done in a thorough and consistent manner is lacking in some areas. EVIDENCE: Each person who stays in a Care Home must have a Service User Plan. This document states the detailed actions staff are to take to ensure that an individuals assessed needs will be met. Two service user files contained Service User Plans that included this information, one contained insufficient detail. One plan was not signed or properly dated. The inspector talked to staff about Service Users needs and they had a good understanding of what help individual’s needs are. Service Users confirmed to the inspector that they felt well cared for and that their needs were met. The door from the Firs requires a code to be able to leave the area. The Inspector was told that every bedroom door was alarmed and these were set at night. It is recognised that it may be appropriate for Service Users to kept safe however such restrictions on liberty must be clearly specified and agreed as part of the Plan for the Individual. Alarming of bedroom doors should not be Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 10 done on a routine basis. If such an alarm is needed it should be done on an individual basis, within agreed parameters and to respond to identified needs. Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Service Users have the opportunity and are supported to follow interests. EVIDENCE: Three files were looked at during this inspection and each Service Users has information on file about how hobbies and interests. From discussion with Service Users they are able to pursue hobbies and interests, and staff encourage Service Users. Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 12 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): 18 Service Users are protected from abuse. EVIDENCE: No new staff have been recruited to Wardhayes, however previous inspections have identified that that there are systems in place to ensure that staff are only recruited when thorough checks have been made. There was information in the home about how to deal with protection issues. Staff in the home confirmed that there was good communication system and support for staff, both of these help ensure that abuse is avoided or dealt with quickly. Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 13 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 and 26 Wardhayes Care Home is comfortable, clean, well decorated, well maintained, and suited to the needs of the people accommodated. EVIDENCE: A brief tour of the building and some of the rooms confirmed that the home is clean and well maintained. Much of the home has been re-decorated and renovated in the last few years. Bedrooms are spacious and well decorated, and bathrooms are well equipped. Two of the lounges and dining areas are domestic in scale and furnished to provide a homely environment. Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 14 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 Wardhayes is well staffed and staff have received training to ensure that they are able to meet individual needs. EVIDENCE: No new staff have been recruited to work at Wardhayes, one person has transferred from similar work in another Devon County Council Home. There were 6 staff (including the duty manager) on duty during this inspection, staff and service users confirmed that there are sufficient staff to meet needs of the people in the care home. If one area of the home is short of staff then staff from another area are able to assist. Three staff in the home confirmed that they had received a range of training to allow them to carryout their work, the training in relation to dementia was thought to be particularly valuable. Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 15 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): 33,35 and 38 There are good management systems in place for the management of Service Users money and for seeking the views of Service Users. Safety systems do not ensure that Service Users are protected from scalding. EVIDENCE: The fire log book for the home recorded that regular checks were being made on this aspect of safety. There was a record of water temperature checks, some of these checks indicated that water was excessively hot, and therefore there could be a risk of scalding. However there appeared to be no record of action taken to remedy this problem. Some Service Users money is held by staff at Wardhayes. There are clear records of transactions, any cash is held securely in safe and the manager on duty confirmed that the system worked well. Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 16 All Care Homes are required to have a system for checking the quality of the service provided and listening to the views of Service Users. The Inspector was shown quality assurance questionnaires that had recently been sent out as part of this process, though as yet the results of this survey had not been completed. Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 17 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 2 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 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 X X 3 X 3 X X 2 Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? 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 OP4 Regulation 14 Requirement The Registered Person must write to each prospective service user and confirm that the home is able to meet their assessed needs. (This requirement has been made at the last three inspections and has not been met). The Registered Provider must ensure that no person has been admitted to Wardhayes without a comprehensive assessment being made of their needs. Each Service User must have a plan that details how their needs will be met, and details the actions are to take to meet these needs. The use of alarms and door locks to restrict the movements of an individual must only be used where there has been discussion and recorded agreement with the Service Users, their representatives and any professionals. The Registered Provider must ensure that where water temperatures have been DS0000032463.V263970.R01.S.doc Timescale for action 01/03/06 2. OP3 14 01/03/06 3. OP8OP7 15 01/03/06 4 OP8OP7 15 01/03/06 5 OP38 13,23 01/03/06 Wardhayes Version 5.1 Page 19 identified as being excessively hot, appropriate and timely action is taken. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wardhayes DS0000032463.V263970.R01.S.doc Version 5.1 Page 21 - 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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