Inspection on 07/08/06 for Wardhayes

This inspection was carried out on 7th August 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Wardhayes 17/02/06

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 7th August 2006 09:30 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 Wardhayes DS0000032463.V301929.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. Wardhayes DS0000032463.V301929.R01.S.doc Version 5.2 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) www.devon.gov.uk 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.V301929.R01.S.doc Version 5.2 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 17/2/06 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 Reablement 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 its 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 its own staff and assigned manager. There is a duty manager on duty in the home at all times. The fees for Wardhayes are £556 per week, additional charges are made for the optician, hairdressing, chiropody, dentist, taxi fares, hospital care, newspapers/gardens, alcohol, telephone calls, personal telephone installation, TV licence, draw tickets, WRVS trolley shop, mobile clothing shop, mobile book/ gift shop, stationary/postage stamps, fish and chip suppers. Wardhayes DS0000032463.V301929.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included two site visits to Wardhayes on 7th August 06 (9:304:00) and 10th August 06 (10:30 – 2:30). During these visits the Inspector looked at all of the rooms, and looked at records relating to staff, service users and safety. The Inspector spoke with Service Users, staff, the manager, a visiting District Nurse and Occupational Therapists. Ten Service User survey forms were distributed and nine were returned. Ten staff survey forms were sent out and nine were returned. A pre- inspection questionnaire was also completed by the manager and returned to the Commission. What the service does well: What has improved since the last inspection? Assessments are now being completed and received by the Manager at Wardhayes before Service Users move. Service Users can feel confident that their needs will be known and taken into account prior to a move. Service User Plans now contain more detailed information about how care needs are to be met. This is important, as people who cannot communicate are not able to tell staff what they need. Wardhayes DS0000032463.V301929.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. Wardhayes DS0000032463.V301929.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 Wardhayes DS0000032463.V301929.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Service Users can feel confident that staff at Wardhayes will be aware of their needs before a move or a visit to the home. EVIDENCE: All seven of the people who responded to a Service User Survey about Wardhayes commented they had received a contract and that that had enough information about Wardhayes to help them make a decision about whether Wardhayes was the right place to move too. When the Inspector looked around Wardhayes, Service User Guides were available in bedrooms. These documents give Service Users information about the home and what they can expect. The admission documents relating to at least one person in each of the three units, was looked at. There was an assessment for each person that included basic information about care needs. It is important that the staff at the home have this information, so that they can ensure that they are able to meet the Wardhayes DS0000032463.V301929.R01.S.doc Version 5.2 Page 9 needs of the individual. There were copies of letters were on file showing that the Manager had confirmed that Wardhayes could meet needs with each person who was to move. Wardhayes provides “intermediate care” which is a service to help people return to their own home. Where individuals had been assessed for these services they were accommodated in either “The Firs” or “the reablement service”, which are specifically designed and staffed for this purpose. Wardhayes DS0000032463.V301929.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area was adequate, this judgement has been made using available evidence including a visit to this service. Service Users can be confident that they will be treated with respect and that that generally staff will know what help they need and will provide it. Information about meeting health care needs was less thorough and could lead to needs not being consistently met. The management of medication is generally good. EVIDENCE: The Inspector looked at the records of care relating to four people at Wardhayes, and spoke to those people and to the care staff on duty. This was to get an understanding of whether each persons needs are being met. The information about how needs are to be met is contained in a document known as a Service User Plan. These documents have been improved since the last inspection. For the people who have dementia they now contain some information about their back ground and lives before staying at Wardhayes. Wardhayes DS0000032463.V301929.R01.S.doc Version 5.2 Page 11 This is useful to help the staff understand each individual, particularly if they have difficulties communicating. A requirement was made at the last inspection that 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 user, their representatives and any professionals involved. This had been done in part, in relation to bedroom doors in the Firs. However alarms were being used in relation to the other doors throughout the building, and there was no record of this. Information on health care needs was less comprehensive. It was noted in the records of one person that they had diabetes that was controlled by diet and tablets. However, there was no further information about the monitoring of the illness or other aspects of care such as skin, foot or eye care. It was noted that one person received medication that would “thin” their blood. There was no reference to this in their care plan or in a falls risk assessment. It was noted that staff were supporting and supervising stoma care. The inspector was told that the District Nurse had visited and had instructed staff in how to provide this care and support. There was no record of what was expected. The staff on duty on the first day of inspection did not know what had been advised, and was using experience gained in a different setting. Where individuals have particular needs then “protocols” or guidance and training should be available to staff to ensure that staff are aware of exactly what to do, and when to seek further advice. A monitored dose system, pre-prepared by the pharmacist, is used. The Inspector observed one of the senior staff administering medication. This was done in a very thorough manner. Service Users were offered pain relief medication, where it was prescribed. Service Users were given plenty of time to take their medication. Where Service Users are given the option of taking one or two tablets, this had some times been recorded, at other times it had not been recorded. The number of tablets administered must always be recorded. It was noted that one person was self-medicating. The inspector was told that this individual was observed for a few days, to ensure that they were safe, however there was no written risk assessment. Each person who self medicates should have a formal risk assessment to ensure that they are safe and receive appropriate support in areas where they may need assistance. There is a record of controlled drugs stored in the home, however there is not a running total of the amounts held. It is recommended that the current system is reviewed so that a running total of the drugs in stock is kept, so that it can be readily audited. The inspector spoke with people on each of the three units and they all confirmed that they were treated with respect and dignity. Seven people Wardhayes DS0000032463.V301929.R01.S.doc Version 5.2 Page 12 completed Service User Survey forms- all confirmed that staff listened and acted upon what they said. They all also said they always or usually got the care and support needed. One person commented, “Carers are so kind and patient. Nothing is too much trouble for them” and “ I am sure my recovery was due to the kindness and caring of staff”. Wardhayes DS0000032463.V301929.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Service users can be confident that they will be able to make choices about their daily lives at Wardhayes. Meals are of a very high standard, well cooked and eaten in pleasant surroundings. EVIDENCE: The Inspector asked Service Users about any rules at Wardhayes, they confirmed that they were able to get up and go bed when they wished, able to choose their meals, and to spend time in their own rooms or in lounges as they chose. The domestic scale of the three units is one way in which individual choices and preferences do not get overlooked. Staff were observed sitting and talking with Service Users, and encouraging individuals to pursue hobbies such as knitting. The Firs Unit has a weekly programme of activities, such as word quizzes. The Firs Unit has a private garden and Service Users are able to enjoy this area without fear of getting lost. Service Users were observed enjoying both gardens, able to arrange the chairs to suit their needs and to have their tea brought out. One person said in Wardhayes DS0000032463.V301929.R01.S.doc Version 5.2 Page 14 their survey that they watched videos, could participate in sing-alongs, and go for short walks. Mrs Westbrooke, Registered Manager, explained that they were able to arrange for Service Users to celebrate special anniversaries. Service Users spoken with said that they were very pleased that staff at Wardhayes had taken the trouble to arrange such a celebrations. Five of the seven service users who responded to a survey said that they always liked the food at Wardhayes, two other people said that they usually enjoyed the food. Meals are cooked on site at Wardhayes. Service users are given a choice of meals at lunchtime, and there is also a choice of a light meal in the evening, specific diets are catered for. There is a dining room for each of the three units. This means that people can eat in small groups. Staff confirmed that Service Users in the reablement unit and in “The Firs” are encouraged to help clear up after a meal if they are able to. Where Service Users need additional support at meals this is provided in a sensitive manner. Wardhayes DS0000032463.V301929.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. There are good systems in place to ensure that Service User complaints will be deal with, and that they will be protected from abuse. EVIDENCE: There is information about how to complain in the Service User Guide, there is a copy of this document were seen in bedrooms during the inspection. All of the Service Users who responded to a survey said that they knew who to speak to if they were not happy and how to make a complaint. The staff on duty at Wardhayes confirmed that no complaints have been received since the last inspection and the Commission has received no complaints. Eight of the nine staff responding to a survey said that they were aware of Adult Protection Procedures. Training records provided as part of the preinspection questionnaire show that the majority of staff, including managers have had training in relation to the Protection of Vulnerable Adults. There are systems in place for the management of service users money. Receipts are kept and all transactions are signed. Wardhayes DS0000032463.V301929.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Overall Wardhayes provides clean and comfortable accommodation for Service Users with a range of needs. EVIDENCE: This inspection included a site visit and tour of the building and garden. The rooms were all clean and tidy, well furnished and comfortable. Much of the home has been re-decorated and renovated in the last few years. The bedrooms are spacious, the bathrooms are well equipped with aides, and the lounge and dining rooms comfortable. A visiting Occupational Therapist confirmed that they were able to adjust the height of furniture, so as to suit the needs of individual service users. The large ground floor toilet used by Service Users has been awaiting redecoration for some years. The walls are now badly marked and the flooring is Wardhayes DS0000032463.V301929.R01.S.doc Version 5.2 Page 17 cracked and stained. The décor is this room is of a poor standard, and is in need of improvement. All seven of the Service user survey forms confirmed that Wardhayes is “fresh and clean”; a tour of the building confirmed this on both days of the site visit. Wardhayes DS0000032463.V301929.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29, and 30 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. There is a good level of staff to provide care and they are well trained and competent to do their work. EVIDENCE: Wardhayes is well staffed; there were staff on duty in each of the three separate units plus a manager, during the site visits. Eight of the staff survey forms returned noted that the Care Plan allowed enough time to provide the care required. The information supplied by the Registered Manager of Wardhayes showed that out of the 38 care staff employed 20 had an NVQ2 or above, a further 3 people were undertaking this qualification. The files of three staff who had recently started work at Wardhayes were looked at as part of this inspection. The files indicated that there had been a thorough recruitment procedure that had included taking references and making Criminal Records Bureau checks. There was a record of basic inductions, and staff were also shadowed in their initial period of employment. Training undertaken by staff at Wardhayes in the last 12 months has included: moving and handling, food hygiene, dementia care training and falls Wardhayes DS0000032463.V301929.R01.S.doc Version 5.2 Page 19 awareness. Eight of the nine staff surveyed said that they were not asked to care for people outside their expertise. Wardhayes DS0000032463.V301929.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35 and 38 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Wardhayes is well managed so that the service meets the needs of the people accommodated. EVIDENCE: The Registered Manager at Wardhayes is Kay Westbrooke. Mrs Westbrooke is qualified and competent to fulfil this role. There is a quality assurance system; the inspector was shown evidence that surveys had been sent out to a number of people who have had regular contact with Wardhayes. The inspector was told shown evidence that these had been returned for correlation. This process has not been competed. Wardhayes DS0000032463.V301929.R01.S.doc Version 5.2 Page 21 As has already been noted there are sound systems in place for the management of finances on behalf of Service Users. These systems include keeping receipts and noting all transactions. There are systems for the management of safety at Wardhayes, though risk assessments had not been recently reviewed. Staff had been trained in relation to fire in July 06, and regular checks had been made on the fire system. There were records of hot water checks, and action had been taken where temperatures were not correct. Wardhayes DS0000032463.V301929.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 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 3 X 3 X 3 X X 3 Wardhayes DS0000032463.V301929.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 OP8 Regulation 15 Requirement 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 relevant professionals. (This requirement was made at the last inspection to be met by 1/3/06) Health care needs must be properly documented in sufficient detail so that staff are aware of how they are to be met. This includes diabetes and stoma care. Timescale for action 01/10/06 2. OP8 15 01/10/06 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 OP9 Good Practice Recommendations The preference of an individual to self- medicate must be DS0000032463.V301929.R01.S.doc Version 5.2 Page 24 Wardhayes 2 3 4 OP9 OP9 OP19 assessed through a risk assessment process. The number of tablets administered should be recorded. The recording of controlled drugs should be reviewed so that there is an accurate record. The ground floor toilet should be redecorated and needs a suitable floor covering. Wardhayes DS0000032463.V301929.R01.S.doc Version 5.2 Page 25 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. 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