CARE HOMES FOR OLDER PEOPLE
Warley House Warley Road Scunthorpe North Lincolnshire DN16 1PL Lead Inspector
Beverley Hill Unannounced Inspection 16th January 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 Warley House DS0000002881.V279643.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. Warley House DS0000002881.V279643.R01.S.doc Version 5.1 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.V279643.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th August 2005 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. Warley House DS0000002881.V279643.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day. The Inspector spoke to the manager and three care staff members who were on duty at the time of the inspection. Throughout the day the Inspector spoke to four people who lived at Warley House. The inspector looked at a range of paperwork in relation to care plans, medication records, staff recruitment, cleaning audits, training records, staff supervision, maintenance and equipment service records and policies and procedures. The Inspector also checked that people who lived in the home had the opportunity to suggest changes and were listened to. The Inspector completed a tour of the building and checked that all the things that needed to be done from the last inspection had been done. What the service does well: What has improved since the last inspection?
Warley House DS0000002881.V279643.R01.S.doc Version 5.1 Page 6 The manager had seen to it that all but two of the things the Inspector had asked them to do at the last inspection had been done. The care plans produced by the home included assessed needs and had tasks that staff needed to complete to meet them. Daily recording had improved and showed the care that staff provided. The home had looked at the way it managed certain medication and made sure clear instructions were in place for staff. The home had purchased ten new commodes. Some maintenance work had been carried out on the homes guttering but some areas in the home were still in need of attention. See the section on ‘what the home could do better’ below. The manager audited bedrooms on a monthly basis to ensure that they were up to standard, clean and tidy and everything was in working order. Key workers also had responsibility to check the provision of toiletries, the tidiness of wardrobes and chests of drawers and support service users to maintain their possessions. What they could do better:
The staff members were unable to monitor service users’ weight for those unable to stand, as the home did not have any sitting scales. This was important as staff needed to make sure that weight did not fluctuate too much and professional advice was sought if there was a consistent loss in weight. Some areas of the environment needed attention. Some bedrooms had exposed pipes under sinks from the heating refurbishment and these needed to be boxed in, some bedrooms, bathrooms and toilets were in need of redecoration. The entrance area was in need of redecoration and a new carpet and some the lounge chairs were in need of replacing. One bedroom only had net curtains as the drapes had been pulled down. The manager was investigating an alternative. This needs to be completed quickly. Some of the bedrooms had lockable facilities and privacy locks to the bedroom doors and service users made use of these. Other people did not want them but the manager should ensure that when the bedrooms become vacant these are installed as standard. Care staff had access to training but the manager needed to make sure that a training plan was in place to meet staffs training needs that had been identified through supervision and annual appraisals. Some staff members were receiving formal supervision but this was not consistent and all care staff must have at least six supervision sessions per year.
Warley House DS0000002881.V279643.R01.S.doc Version 5.1 Page 7 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. Warley House DS0000002881.V279643.R01.S.doc Version 5.1 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.V279643.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 The home was able to meet the current needs of service users admitted to the home. EVIDENCE: The home completed assessments of need prior to admission and obtained assessments completed by care management. This enabled them to develop a care plan to meet the needs. Care plans had improved since the last inspection. Staff members spoken to commented that they had enough equipment in the home to enable them to meet peoples needs. The district nursing services provided any specialist equipment such as airflow mattresses. Staff had access to mandatory training courses and those specific to the needs of current service users. All staff members had completed a dementia awareness course provided by the Alzheimer’s Society and facilitated in-house. This consisted of a video, completion of four units with set questions, a reflective account of the training and assessment by the manager.
Warley House DS0000002881.V279643.R01.S.doc Version 5.1 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 and 10 Improvements were noted in the way care plans were updated to reflect changing needs and the way medication was recorded and the home ensured that the privacy and dignity of service users was promoted during care practices. The home had no method of monitoring the weight of service users unable to stand and therefore no means of determining whether professional support was required other than visual means. This could place people at risk of inadequate care and professional support. EVIDENCE: Improvements were noted in care plans. These were assessed thoroughly at the last inspection so the issues that resulted in requirements were assessed at this inspection. Three care plans were examined and there was evidence that staff updated them when needs changed and there were generally clear tasks for staff to enable them to meet assessed needs. Care staff ensured that daily recording covered the care service users received throughout the day and night. However the home was unable to monitor service user weights if they were unable to weight bare, as they did not have
Warley House DS0000002881.V279643.R01.S.doc Version 5.1 Page 11 sitting scales. This meant that staff had no way of knowing if weight was fluctuating and the service user required professional advice and support. This element of health monitoring needed addressing. The home continues to manage medication well. Improvements were noted in the way instructions were written down on medication records and clearer guidance for staff was in evidence for those service users requiring medication to alter their behaviour. The manager had produced a new medication record for use when service users were admitted for respite care. This gave ample space for instructions and was an improvement on the previous form. Service users spoken to described care provided that promoted their privacy and dignity. For example staff members knocked on doors before entering, staff left the room if asked to, they closed doors and made sure curtains were closed, mail was delivered unopened, people were able to see visitors in private if they chose to, staff called people by their preferred name and spoke to them in a nice way. Shared room had privacy curtains. Warley House DS0000002881.V279643.R01.S.doc Version 5.1 Page 12 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 and 14 The home promoted community links and encouraged contact with family and friends. Service users were able to make decisions and have choices about aspects of their lives. The home did not provide activities that met all service users needs. EVIDENCE: Service users spoken to confirmed that visitors were welcomed into the home at any time and there were no fixed routines. The manager confirmed that one service user was re-establishing community links with friends and a social club. The standard relating to social and activity provision was not fully assessed at this inspection but two service users spoken to felt that there were insufficient activities for them to do. One expressed a desire to go out for a walk and relayed to the inspector a time when the home had a dog and staff and the service user used to take it out for walks. Clergy visited the home to conduct services and the home had visiting entertainers occasionally. Service users accessed local amenities such as shops and pubs and the library visited to exchange books. A local lifestyle group had links with the home and last year completed a gardening project. Warley House DS0000002881.V279643.R01.S.doc Version 5.1 Page 13 Staff members spoken to described how they tried to ensure service users had choices about the home and their lives, for example people were asked if they were ready to get up and go to bed, what clothes they would like to wear that day, what choices they would like at mealtimes and whether they would like to join in activities. Service users could choose the gender of their carers and staff described how they encouraged people to be as independent as possible. Service users confirmed they were asked about rising and retiring and the meals they would like to have. Service user meetings were held were suggestions could be made. One person described how they had suggested a change to the menu and this had been followed through and another stated they had chosen the colour scheme for the quiet lounge, light green and restful. Some service users managed their own personal allowance and had lockable facilities for this. Bedrooms were personalised to varying degrees. Some service users smoked and a room had been designated for them away from the main communal area. Warley House DS0000002881.V279643.R01.S.doc Version 5.1 Page 14 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 The home protects service users from abuse by training staff, good recruitment and adherence to policies and procedures. EVIDENCE: All staff within the home had received training in the protection of vulnerable adults from abuse and all had signed to say they had read and understood the adult protection policy and procedure. Eight staff including the manager had completed training by the local authority. The home had policies and procedures that linked to the multi agency policies and procedures and staff members spoken to were aware of what to do if they suspected abuse had occurred. The home recruited staff members in a way that protected service users and ensured that appropriate documentation was in place prior to the start of employment. Warley House DS0000002881.V279643.R01.S.doc Version 5.1 Page 15 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, 20 and 24 Some areas of the environment need attention to ensure service users live in comfortable and pleasant surroundings. EVIDENCE: The building used to be owned by the local authority and was a purpose built residential home for older people. When the new owners took over, the home required quite an extensive refurbishment to bring it up to standard. The windows have not yet been painted although the directors have granted funding for this work. Eventually the windows will need replacing. The gutters have been cleared since the last inspection. Little redecoration has been completed since the last inspection and the entrance, main corridor and several bedrooms were in need of refreshing. There had been no progress with regards the work that needed completing under sinks in service users bedrooms and some bathrooms and toilets were still in need of refurbishment. The manager confirmed that funds were available for the joinery work under sinks and the redecoration of bedrooms but an employment dispute had affected timescales. Quotes had been
Warley House DS0000002881.V279643.R01.S.doc Version 5.1 Page 16 received regarding a new carpet for the entrance and corridor and the redecoration process had been started. The home had provided ten new commodes since the last inspection. The home had several communal lounges and a large dining room from which patio doors opened into an enclosed garden area. There is also a designated smokers lounge and an area in the entrance where some service users preferred to sit. Those spoken to felt the home had enough communal rooms and quiet areas. Some of the chairs in communal areas were jaded and in need of replacement. Bedrooms were personalised to varying degrees and some people had brought in their own furniture. One bedroom needed alternative window covering as the curtains had been pulled down. The manager confirmed that a blind was being considered. The home needs to produce a refurbishment plan that details timescales for completion of the windows, areas under sinks in bedrooms, redecoration of the entrance and corridor, redecoration of some of the bedrooms and replacement of some of the jaded chairs. Warley House DS0000002881.V279643.R01.S.doc Version 5.1 Page 17 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): 28, 29 and 30 Service users were cared for by staff members who had been recruited appropriately and had received training for their roles and tasks. EVIDENCE: Two new staff files were examined and both evidenced that appropriate recruitment practices had been maintained. Both contained the required documentation and had been gathered prior to the start of employment. Induction for new staff members was competency based and signed off by senior staff when completed. The manager was updating induction documentation in line with current changes in Skills for Care standards. There was evidence of the manager and staff member’s commitment to training and funding had been explored for NVQ’s. A training plan had been produced in the company’s business and financial plan for 2005/2006, however the manager confirmed that training requirements for 2006/2007 would be identified via appraisals, which were due but had not been completed yet. Three individual training records were examined and detailed that staff had access to a range of training courses. Mandatory training was covered and some service specific such as dementia awareness, risk assessment and care planning. All staff members who administered medication had completed a certificated Safe Handling of Medication course. Nine staff members had completed NVQ Level 2 and 3 and a further eleven were progressing through the courses. When those progressing through the
Warley House DS0000002881.V279643.R01.S.doc Version 5.1 Page 18 training completed it the home would have more than 50 of care staff trained to NVQ Level 2 or above. This would be a very good achievement. Warley House DS0000002881.V279643.R01.S.doc Version 5.1 Page 19 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, 35, 36 and 38 The manager provided leadership and guidance to staff and ensured the environment was a safe place to live and work. The inconsistency of supervision meant that some care staff members were not monitored effectively and this could place the service users at risk of inadequate care. EVIDENCE: The registered manager had been in post for the past four years. They were progressing through the Registered Managers Award but this has been put on hold whilst the manager investigated further options, for example NVQ level 4 in care. The manager had completed an Advanced Management in Residential Care course with North Lindsey College and had been recently advised that this was acceptable as the management section of the training and only the care component was required. The manager was also a moving and handling trainer. They had also completed an NVQ Assessor Award and an Adult
Warley House DS0000002881.V279643.R01.S.doc Version 5.1 Page 20 Education Facilitator course. The manager had an HND in Business and Finance. Service users and staff members spoken to described the manager as approachable, supportive and easy to talk to. They stated the manager was always out and about the home and service users knew the managers full name. There was evidence that the home managed the finances of service users appropriately. Mainly families managed finances but the home collected giros for three people and documented inputs and outgoings on individual logs. A small amount of personal allowance was held at the home for eleven people. Individual records and receipts were maintained. The manager audited finances on a weekly basis. Some service users managed their own finances, especially their personal allowances. Staff supervision was taking place and discussions were documented. Three files were examined and detailed that staff were receiving between three and five sessions a year. Staff members spoken to state they generally had supervision every two months but this was not consistently the case. The manager stated they received supervision from one of the directors but they did not keep notes regarding these meetings. Further support from the directors took place at monthly meetings, which followed the managers meeting. The manager was proactive in promoting the safety and wellbeing of the service users who lived at the home and the staff who worked there. Servicing of equipment records were maintained and fire prevention management was in place including training, drills and equipment checks. Staff completed health and safety training. The health and safety officer visited on 6.1.06 and a plan had been made to address shortfalls. The local fire safety officer visited on 27.9.05 and gave recommendations re updating the fire risk assessment, which had been completed. The environmental health officer visited on 2.11.05 and left no recommendations. Warley House DS0000002881.V279643.R01.S.doc Version 5.1 Page 21 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 x 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 1 3 x x x 2 x x STAFFING Standard No Score 27 x 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x x 3 2 x 3 Warley House DS0000002881.V279643.R01.S.doc Version 5.1 Page 22 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 OP12 Regulation 12(1)(a)& 16(2)(n) Requirement The registered person must ensure a range of activities is provided to meet all needs (previous timescale of 30/09/05 not met) The registered person must ensure that maintenance tasks such redecoration under sinks are completed. (Previous timescale of 28/2/05 not met) The registered person must ensure that the home has the means to monitor service users weights. The registered person must ensure that a redecoration and refurbishment plan is produced that sets out timescales for the completion of decoration under sinks in some bedrooms, the foyer, some bathrooms and toilets, replacement of the foyer and main corridor carpet and replacement of several chairs. The registered person must ensure appropriate coverage for one specific window to maintain privacy.
DS0000002881.V279643.R01.S.doc Timescale for action 28/02/06 2 OP19 23(2b) 31/03/06 3 OP8 12(1)(a) 28/02/06 4 OP19 23 31/01/06 5 OP24 23 10/02/06 Warley House Version 5.1 Page 23 6 OP30 18 7 OP36 18 The registered person must ensure that a training plan is produced gained from information in staff appraisals and supervision and includes updates for mandatory training. The registered person must ensure consistency with supervision to enable care staff to receive at least six formal sessions per year. 28/02/06 28/02/06 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 2 3 4 Refer to Standard OP24 OP28 OP31 OP36 Good Practice Recommendations The registered person should ensure that privacy locks and lockable facilities are provided as standard when service users vacate a bedroom that does not currently have one. The home should continue to work towards 50 of care staff trained to NVQ Level 2. The registered manager should complete NVQ Level 4 in care to work alongside their management certificate. The manager should maintain records of supervision sessions with the directors. Warley House DS0000002881.V279643.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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