Inspection on 12/07/07 for Warley House

This inspection was carried out on 12th July 2007.

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

Warley House 18/08/09

Warley House 11/07/08

Warley House 20/07/06

Warley House 16/01/06

Warley House 17/08/05

Warley House 26/11/04

Warley House 01/06/04

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Warley House Warley Road Scunthorpe North Lincolnshire DN16 1PL Lead Inspector Ms Matun Wawryk Key Unannounced Inspection 12th July 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Warley House DS0000002881.V346030.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. Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Warley House Address Warley Road Scunthorpe North Lincolnshire DN16 1PL 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) 01724 861507 Barton Medical Services Limited Tracey Anne Borrill Care Home 39 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (39) of places Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th July 2006 Brief Description of the Service: Warley House is a Care Home providing personal care and accommodation for thirty-nine older people, twenty of whom may have a diagnosis of dementia. They provide a day care service for up to five people per day. The home is situated in a housing estate in Scunthorpe some distance from the town centre and local amenities, although on a local bus route. The building is of an old style and the home is currently undergoing a redecoration and refurbishment programme. There is an enclosed garden at the rear of the property and a separate house within the grounds, which has been developed into a laundry. Warley House consists of a two-storey building serviced by a passenger lift and stairs. The home has twenty-one single and nine shared bedrooms, none of which have en-suite facilities. The home has four sitting rooms and a large dining room. There is also a smaller quiet dining room on the upper floor but it tends to be used as a training room for staff. Just inside the main entrance is another smaller seating area, which is part of a thoroughfare but attracts some people, who want to sit and watch what goes on. The home also has a designated smoking room and a staff sleep-in flat. The home has five assisted bathrooms and sufficient toilets appropriately sited throughout the home for ease of access. Information given by the manager in the pre inspection questionnaire states the home charges between £329 and £495 per week. The home also charges third party top-up fees for publicly funded people. In addition people are expected to pay for hairdressing, private chiropody treatments, toiletries and newspapers/magazines. More up to date information on fees and charges can be obtained from the manager of the home. Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the homes first key inspection of 2007/08. The site visit took place over one day in June 2007. Mrs Matun Wawryk carried out the visit. Prior to visiting the home the inspector sent out survey questionnaires to a number of people living in the home, relatives and professional staff to try and establish whether peoples needs were being met. Five residents, four relatives, five professionals and three staff returned a questionnaire at the time this report was written. Some of the comments received by these people have been included in this report. During the visit the inspector spoke to eight people living in the home, one relative, one visiting district nurse, the manager, the administrator, and four care workers to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. The inspector also looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. The inspector also checked with people to make sure that their privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. The inspector also observed the way staff spoke to people and supported them and checked out with staff their understanding of how to maintain peoples privacy, dignity, independence and choice. Information received by the Commission over the last few months was also considered in forming a judgement about the overall standards of care within the home. What the service does well: There was a very relaxed and homely atmosphere in the home, people were observed to be very settled and comfortable in their surroundings. The home was clean and tidy and domestic staff work hard to maintain cleanliness. All the people spoken to were happy with their rooms and cleanliness of the home in general. Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 6 People spoken to and those who returned a questionnaire said they were satisfied with the overall care provided by the home. People were complimentary about the staff team stating they were kind and caring and supported them well. A number of staff had been at the home for many years and they provided consistent care. People and relatives spoken to during the visit told the inspector that they had chosen the home for reasons such as: the friendly atmosphere, the facilities/ location and the kindness and friendliness shown by the staff. People said they had good access to professional medical support when needed. People also said that they were able to access external services such as chiropodist and opticians as needed. One visiting nurse said ‘ the staff are very good, they seek advice appropriately and act on any advice given’. People living in the home said they were offered a good choice of meals and that they enjoyed the quality of food. Specific wishes were catered for and people said they had plenty to eat and drink throughout the day. Comments from people included ‘excellent food’, the food is lovely’, two people said some meals ‘could be hotter’. This matter was referred back to the manager for her to address. People living in the home said their family and friends were made to feel welcome by staff when visiting the home and that they can visit when they please. What has improved since the last inspection? What they could do better: Activities are provided and information given by some people indicates they are satisfied with activities on offer in the home, however this is not the case for all. Two people spoken to said there was not enough to do in the home, and one person wrote in their survey ‘not enough activities, could do with something to occupy my mind’. One staff member also wrote in their survey ‘it would be great to be able to spend more quality time on a one to one basis with clients’. These comments indicate residents would benefit from a broader range of activities including one to one support. Although cleaning staff work hard to keep the home clean and staff have redecorated some people’s bedrooms, the home is in need of significant redecoration and refurbishment. Carpets in some areas including some bedrooms and corridors are marked and stained, furniture in some bedrooms Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 7 and communal areas are old and worn and need replacing and paintwork in corridors is scratched and unsightly in places. Whilst these matters do not pose a health and safety risk they do not ensure people live in an attractive and comfortable home. New owners have recently taken over the home and they have said that they intend to reburshish the home before the end of this year. All the staff were receiving one to one supervision from the manager or named supervisor but this was not happening as often as it needs to for some staff. Some staff needed to be provided with more regular, formal support to ensure they are provided with the appropriate guidance and leadership they need and to receive management feedback on their performance. 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. Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 8 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 Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 9 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): 2 and 3 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are made to feel welcome and secure and people can be assured their needs will be met as a result of robust assessment processes. EVIDENCE: Three care files were examined in detail and two others were perused for specific issues during the inspection and it was clear that the manager ensured assessments of need prior to admission were completed and that staff obtained copies of assessments/care plans completed by care management. This enabled them to decide whether the person needs could be met within the home and to develop a care plan to meet the persons needs. There was no Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 10 evidence in the files to show that the manager formally wrote to people or their representatives following assessment to confirm the home was able to meet the needs of the person, this should now happen for new admissions. There was evidence that people were issued with a contract or statement of terms and conditions, however these were not up to date in all cases. The home charges additional fees (third party top-ups) for people whose care is publically funded, the manager gave an assurance that this was always paid by a third party. Some people spoken to were aware that an assessment of their needs had taken place and that a care plan had been formulated to meet their needs. There was good evidence to demonstrate that care staff were accessing a range of service specific training which will help ensure that they have the skills to enable them to deliver up to date care methods and have a better understanding of the varied conditions common to older people. Information given by people living in the home and staff indicated that there was sufficient equipment within the home to meet a range of needs. Specialist equipment was obtained via district nursing services as required. Staff in interview confirmed that they understood the admission process and were aware of the importance of ensuring new residents were made to feel welcome. Residents and one relative spoken to during the visit told the inspector that they had chosen the home for reasons such as: the friendly atmosphere, the location and the friendliness shown by the staff. One individual spoken to said ‘I was brought here by my family to see the home and talk to the staff before I made the decision to stay’. One relative told the inspector that his mother had ‘settled into the home very well’, he visits the home regularly and said he always found the staff to be polite and friendly. One relative wrote in their survey ‘good standards of cleanliness, staff friendly and supportive’. People are able to make a limited choice of staff gender when deciding whom they would like to deliver their care, as the home had one male carer as well as female carers. The manager said this matter was discussed with people during the assessment and care planning process. Information from the Pre-Inspection Questionnaire prior to the inspection and discussion with the staff and observation on the day indicates that all the people living in the home are white/British. The manager said staff would be able to support individuals with specific cultural or diverse needs following a needs assessment being completed. And where necessary additional training and guidance would be provided to staff to enable them to be responsive to the resident’s needs. Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 11 The home does not accept intermediate care placements so standard six does not apply to this home. Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 12 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): 7, 8,9 and 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples health and social care needs are well met, this is achieved through detailed care planning processes and good management of peoples health needs. EVIDENCE: Case tracking took place for four people. The methodology used was a physical examination of care plans; written surveys to people living in the home, relatives, health and social care professionals and direct observation on the day. Some of the care plans examined were more comprehensive than others. Two care plans were very detailed and referred to levels of independence, privacy Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 13 and dignity. The other two care plans detailed people physical care needs but did not clearly set out the persons routines and preferences for the way in which care should be delivered. This is particularly important when people have memory impairment difficulties, which makes it difficult for them to articulate their care needs. The manager was aware of what aspects of peoples care plans needed to be improved and gave an assurance that plans were in place to address this with staff. Record identified that care plans were evaluated on a monthly basis and were updated as people’s needs changed. There was also evidence that some people had signed agreement to their care plans. Some people spoken to knew they had care plans, whilst others said they had no interest in reading their individual plans. From discussions with people and examination of documentation and observation it was evident that people living in the home were supported in personal care tasks by staff who respected their privacy and dignity. Risks were identified in relation to nutrition, pressure sores, moving and handling. There was evidence of professional input from dieticians and district nurses and all the people living in the home were registered with a GP. There was evidence that people were weighed regularly. Specialist equipment for example, specialist beds, mattresses and seat cushions were obtained for people who needed them. One professional wrote in their survey ‘I have always found the staff to be proactive in seeking early medical intervention and they always inform me of issues relating to the service users I am responsible for’. The home uses a Monitored Dosage System for medication and only senior care workers administer medication. Information in the pre inspection questionnaire submitted by the manager identified that policies and procedures for medication were in place and only staff who have completed medication training administer medication. Medication systems were examined at this visit. Temperature recordings of the refrigerator were taken and were satisfactory. Staff were not routinely monitoring the temperature of the room used to store medication. This should now happen to ensure the temperature does not exceed the manufactures guidelines. Staff were sometimes handwriting medication (transcribing) on to the medication administration record (MAR), a second member of staff was not witnessing the entry to confirm the information was correct. In order to ensure proper safeguards are in place the manager was advised to ensure a second member of staff witnesses all hand written annotations on the MAR. The manager was seen to take steps to address this with staff at the visit and because of this a good practice recommendation has not been made. Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 14 Controlled Drugs in current use were stored in a controlled drugs cabinet and an appropriate register was in use. The quantities of controlled drugs in stock matched the balances recorded in the register. Others areas of medication management in relation to receipt, storage and stock control were appropriate and effective. People spoken to confirmed that care was provided in a way that respected their privacy and dignity. The inspector observed staff speaking to people in an appropriate and caring way. Analysis of the surveys received together with discussions during the visit identified that everyone was satisfied with the quality of care provided at the home and the attitude of the staff; comments included “ I have been very impressed with the carers at Warley House, I have appreciated their kindness and concern towards my mother and myself”, ‘the staff are very helpful’. One relative wrote in their survey ‘I watch the staff treat each one with care that is needed at the moment’, one professional wrote ‘good support from key workers and other staff in escorting SU to their GP etc, ‘Staff always open to suggestions about how to accommodate my SU needs’, another wrote ‘in many placements both permanent and respite I feel confident and secure that they are well cared for both physically and emotionally’. Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 15 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): 12,13,14 and 15. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are enabled to keep in contact with family and friends and people receive a healthy, varied diet according to their assessed needs and choices. People have access to recreational and social activities, but further improvement in this area is needed to ensure everyone living in the home experiences a full life with opportunities to take part in varied activities according to their assessed needs and preferences. EVIDENCE: The home did not employ an activity coordinator, one staff member dedicated for day care with support from care staff organised and arranged activities in the home. The home had various separate rooms to accommodate a range of activities, including relaxation with soft lights. Staff recorded activities provided and who had participated. The activities on offer ranged from one to one and group sessions for example; games nail care to visits to local shops and Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 16 facilities and some occupational tasks such as setting the table and wiping tables. Generally people spoken to and those who returned a survey said they were happy with the level of activities available to them. Two people spoken to said there was not enough to do in the home, one person wrote in their survey ‘not enough activities, could do with something to occupy my mind’. These comments indicate staff may need to look more closely at people’s social and recreational needs. This matter was discussed with the manager who gave an assurance that activities provision was regularly discussed with people living in the home, but acknowledged more could be done particularly for those with more significant care and support needs. People spoken to who were able to express an opinion said they felt staff listened to them and said they were able to exercise choice in aspects of their life and daily routines. In discussion staff displayed a good knowledge of individual resident’s needs, likes/ dislikes, family support and records contained information about people’s religious observances. A priest and local vicar visited the home on a regular basis. Staff spoken to had an understanding of how to promote peoples privacy, dignity, independence and choice, staff said things `like ‘we try and get to know what people like as soon as they come in’, ‘we always make sure doors and curtains are closed’, ‘ we offer two choices at lunch and alternatives’, ‘we don’t have any set routines’. People spoken to said visitors could come at anytime and could be seen in private. This was confirmed in discussion with staff and in surveys received from professional staff. One professional wrote ‘always provided with a private room to see my service user’. People spoken to said staff knocked on doors prior to entering and supported them in a nice way. Relatives commented in surveys that staff kept them informed, ‘ they ring me if there is a problem’, ‘they treat people with respect and try to maintain dignity and explain what they are doing when they assist them, they do a good job’. The home provides three meals a day and a light supper. The manager said there were no restrictions on what food could be ordered and this was confirmed in discussion with other staff. Menus on display indicated that a choice of food was provided; alternatives to the two main choices at lunchtime are provided where required. At the last inspection it was noted high noise levels during the lunchtime meal and that staff were trying to support two people to eat at the same time. The lunch period as again observed as part of this inspection. Action had been taken to address issues identified in the last inspection report. Four staff were in the dinning room. Staff were observed to sit next to people who needed support to eat their meal and support was provided in a sensitive manner. Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 17 People spoken to and those who returned a survey confirmed that generally the home provides a good standard of meals, which people enjoyed. Comments included ‘ the food is excellent’; another person said ‘meals are plentiful and good variety served’. Two residents told the inspector that some meals ‘could be hotter’. One person wrote in their survey ‘less chips, more mash’. These matters were referred back to the manager for her to review. The home caters for people on low fat and diabetic diets. The manager said other specific dietary needs would be accommodated where this was needed. Warley House DS0000002881.V346030.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): 16 and 18 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints system was in place and people living in the home, staff and others are assured complaints and concerns will be listened to any allegations acted upon. Failure to operate robust recruitment practice could put people at risk if not addressed. EVIDENCE: No complaints about the home had been referred to the Commission since the last inspection carried out in July 2006. Records indicated the manger dealt with internal complaints made to her appropriately. A complaints procedure was in place and staff spoken to said they had no complaints about the home and felt confident to raise issues of concern if they arose with the manager. Most people spoken to said they knew who to report concerns or complaints to. Three residents who had memory impairment problems were unable to say whom they would speak to if they had any concerns. One visiting relative spoken to said they were aware of the complaints process and all the people Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 19 and relatives who returned a questionnaire said they were aware of the complaints procedure. Information from the Pre-Inspection Questionnaire and discussion with the manager indicates the home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing and management of resident’s money and financial affairs. People spoken to said they felt ‘safe’ in the home. When asked about abuse, what it was and what they would do if they suspected or saw or suspected any abuse staff stated that they would report it to the manager or senior care worker. Examination of a sample of individual staff training records showed staff had been provided with training in safeguarding adults. Staff interviewed also had a good knowledge of whistle blowing procedures. No safeguarding referrals had been made to the local authority since the last inspection. The manager was not always following good practice when recruiting new staff this could adversely affect the welfare of people living in the home if not addressed. Please refer to comments on page 25 of this report. Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 20 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): 19 and 26 People who use this service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are provided with a clean home but extensive redecoration and refurbishment is needed to some parts of the home. Whilst these matters do not pose a health and safety risk they do not ensure people live in a comfortable and attractive home EVIDENCE: It was evident from talking to staff and observation that cleaning staff worked hard to keep the home clean. Staff had also redecorated a number of the bedrooms to improve the environment for people living in the home. Despite this extensive redecoration and refurbishment was needed. Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 21 A tour of the home was carried out and all areas seen were clean and tidy and the home was free of offensive smells and odours. People spoken to and those who returned a questionnaire confirmed the home was kept clean. One relative wrote in their survey ‘the home needs a lot of old furniture replacing which I believe is an ongoing thing. Funding for a shower room would benefit residents’. One professional wrote ‘the physical facilities could be improved’. As identified in the last inspection report the hallway carpet near the dining room and the stair carpet at both ends of the building was in need of cleaning or replacement as it was badly marked and stained. Some corridoors also had chipped and unsightly paintwork. All bedrooms seen were clean and tidy and many people had furnished their rooms with a range of personal items, to reflect their own individual choice and taste. Some bedroom doors had privacy locks and some of the bedrooms had lockable facilities. A number of bedrooms were in need of redecoration, some carpets were worn and marked. Storage facilites in some rooms was old and some beds were also noted to be old and worn. This said people spoken to said they were happy with their rooms. The dinning room floor covering was marked and damaged in places and the dinning room furniture was old and worn. The manager said she had obtained a grant form the local authority and that this money would be used to refurbish the dinning room. Chairs in some of the sitting areas had been replaced, but there were still a number of chairs, which were old and worn and should be replaced. Since the last inspection new owners have taken over the home and they have said they intend to fully refurbish the home this year. The manger and staff were aware of what aspect of the homes environment needed improvement and there was evidence the manager had discussed these matters with the new owners. It is important that the new owners put in place and make available to the Commission an up to date refurbishment and renewal plan for the home, including the dates when work is to commence. The pre inspection questionnaire states that a fire risk assessment was in place. This was not checked at this visit. Staff in interview confirmed adequate supplies of protective clothing. Equipment provision was also discussed and staff said there were appropriate mobility aides in the home to enable resident’s needs to be met. Records showed that equipment and aids are serviced and maintained to the appropriate standards to ensure their safe use. One relative wrote in their survey ‘keep the wheelchairs cleaner, clean the carpets’ Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 22 The home is built on two floors with flat walkways inside and out, providing safe and secure footing for people with limited mobility. Access to the upper floor is by use of a passenger lift and staircase. People spoken to said they had not experienced any particular problems with their laundry, and all said cloths were washed and ironed appropriately. Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 23 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): 27, 28, 29 and 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staffing levels are satisfactory and staff are trained and competent. Recruitment practice was generally satisfactory, but failure to ensure all necessary records are obtained before people start working in the home could put people at risk if not addressed. EVIDENCE: The roles and responsibilities of staff are clearly defined and in discussion with the inspector staff demonstrated understanding of the management and reporting structures for the home. The manager of the home stated that the Residential Forum Guidance is used to calculate staffing hours and information about care hours provided and dependency levels of people living in the home indicated this was followed. Staff spoken to said there was generally enough staff on duty at any one time to enable peoples needs to be met, but commented that occasionally they were short staffed due to sickness problems. Three staff returned a survey. In Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 24 response to the question ‘are there sufficient numbers of staff on duty to enable residents needs to be met’ all three said yes. One staff member wrote in the survey ‘sufficient staffing other than holidays and sickness, it would be great to be able to spend more quality time on a one to one basis with clients’. Evidence from surveys and discussions with residents during the visit confirmed that they were generally satisfied with the care they received. Residents commented on how kind and supportive the staff were. One resident said ‘I am very pleased with the care at the home, another person said ‘I am very happy with the staff’. Comments from other residents included ‘staff to busy to sit and talk’, ‘ staff always busy’. One relative wrote ‘get more staff’, another wrote ‘I still find it difficult to have my parent in a home, but I couldn’t wish for more care than the staff give my mother’. Comments from professional staff included, ‘Staff always open to suggestions about how to accommodate my SU needs’, ‘I have placed several people at Warley House and have no concerns that they do not respond to individual needs’ The manger said the home had an equal opportunities policy and procedure, although the inspector did not examine this. Feedback from the manager, staff and information in personnel and training records showed the procedure is followed when employing new staff and throughout the homes working practices and staffs access to training. Employment records for one staff member appointed since the last inspection were examined. Records were generally in good order although the inspector noted that two verbal references had not been followed up with written ones. Other relevant documentation to comply with Schedule 2 of the Care homes Regulations had been obtained. The need to ensure all records are obtained before staff start working in the home was discussed with the manager New staff are provided with an induction and the manager had an induction programme which meets Skills for Care Common Induction Standards specification. A workbook is provided as part of the induction and this is completed with the staff member’s supervisor. The home had a training plan and examination of a sample of eight staff records evidenced that mandatory safe care, general and service specific training was covered and certificates were in place to support recent training courses the staff had accessed. Training consisted of in-house training, distance learning and external facilitators. Specialist training in dementia care was provided inhouse and the manager had collated health and social care information in a resource folder for staff information The home had a good National Vocational Qualification training programme for staff. The pre inspection questionnaire indicated the home exceeded the target of 50 of care staff trained to level 2 or above, which is a very positive Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 25 achievement and records indicated that a number of other staff had been enrolled to complete an award. Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 26 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): 31, 33, 35, 36 and 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A competent and experienced manager manages the home and the manager reviews aspects of the homes performance through a regular programme of audits and consultations. Resident’s safety was well promoted and protected. EVIDENCE: The manager is experienced and has recently successfully completed a National Vocational Qualification at level 4. Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 27 Staff confirmed that moral was good and commented that there was a good team approach to the care delivery at the home. Evidence from staff interviews indicated that staff consider the manager and senior staff to be very approachable. Staff said they take issues raised seriously and take prompt action to resolve matters where this is needed. Comments included ‘the manager is extremely helpful’, ‘she is understanding and approachable’, the atmosphere and communication in the home is good’, ‘manager needs to be stricter with people who regularly go of sick’. One professional wrote in their survey ‘I have always found the manager and senior staff to be very competent and proactive, always very willing to look at how individual needs/changes can be best managed’. The provider organisation has developed systems for quality assuring its services including regular audit and surveys of residents, their relatives, staff and other key stakeholders and inspection of these confirmed that they were generally being maintained well and kept up to date. The home had achieved the local authorities Quality Development Scheme Gold Award and had retained the Investors in People Award. The home only keeps a limited amount of money within the home for residents. Samples of records were checked and these were found to be in good order and money held balanced with the records. A staff supervision programme was in pace and all staff had a named supervisor. Records showed some staff receive regular supervision however there were gaps, examination of a sample of records showed not all staff were accessing the required amount of supervision sessions (six) within twelve months. This is important because staff need to be provided with the appropriate guidance and leadership to receive management feedback on their performance. Information gathered from the pre-inspection questionnaire indicated that there are a range of policies and procedures in place for health and safety. Safe working practices are maintained by the provision of training to staff in the form of moving and handling, basic food hygiene, basic first aid, infection control and fire safety. Training records evidenced that the majority of staff had received this training and further training was planned. Information in the pre-inspection questionnaire also indicated that maintenance certificates were in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and in most cases regulation 37 reports are completed and sent on to the Commission where appropriate. The inspector noted at the visit that one person was in hospital; the Commission had not received a notice about this. The manager is advised to ensure notices are sent to the Commission without delay. Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 28 The manager had completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding moving and handling and daily activities of daily living. Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 29 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 2 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 x x x x x x 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 x 3 Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 30 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 OP2 Regulation 5 (1) (b) Requirement Timescale for action 30/09/07 2 OP12 16(2)m and n 3 OP19 23 The registered person must ensure each resident be given a personalised statement specifically relating to the care, accommodation etc that they will receive for the fee being paid. This should be supplied, at the latest, at the point at which someone takes up residence in the home. It is important that fee information is widely available at an early stage to support people to make informed choices. Further information about this can be found in the revised Care Homes Regulations. 30/09/07 The registered person must ensure that all people living in the home are provided with a range of appropriate meaningful activities, which are suited to their assessed needs and preferences. This will help to ensure residents do not get bored and that they have access to activities which are meaningful and appropriate to their needs and capabilities. The registered person must 14/09/07 ensure that the maintenance DS0000002881.V346030.R01.S.doc Version 5.2 Warley House Page 31 4 OP19 23 plan includes timescales for the redecoration of the remaining bedrooms, toilets and bathrooms, the redecoration of the damaged upstairs corridor and paintwork in the downstairs corridors and the refurbishment of some bathrooms and toilets especially flooring. Timescale of 31/08/06 not met. The registered person must 31/08/07 ensure that the badly stained carpets near the dining room and on the stairs are cleaned or replaced and carpets in some of the bedrooms cleaned. Timescale of 31/08/06 not met. The registered person must ensure people do not start working in the home until two satisfactory written references have been obtained. Ensuring robust recruitment and selection practice is one way the registered person can protect people living in the home from harm as far as practicable. The registered person must ensure that all care staff receive formal recorded supervision as a minimum of the recommended six times per year. This is needed to ensure staff receive necessary guidance to do their job properly and to ensure they receive feedback on their performance. 31/07/07 5 OP29 19 6 OP36 18(2) 31/10/07 Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 32 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 manager should routinely monitor the temperature of the room used to store medication to ensure the temperature does not exceed the manufactures guidelines. Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Warley House DS0000002881.V346030.R01.S.doc Version 5.2 Page 34 - 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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