CARE HOMES FOR OLDER PEOPLE
Warley House Warley Road Scunthorpe DN16 1PL Lead Inspector
Bev Hill Unannounced 17 August 2005 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 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 J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Warley House Address Warley Road, Scunthorpe, DN16 1PL Telephone number Fax number Email 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 Ltd Tracey Borrill CRH 39 DE(E) 20 Category(ies) of OP 39, registration, with number of places Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 26.11.04 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/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 J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 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 who were on duty at the time of the inspection. Throughout the day the Inspector spoke to eight people who lived at Warley House and one relative. The inspector looked at a range of paperwork in relation to staff rotas, quality assurance, care plans, accidents, medication records, risk assessments, menus, policies and procedures and complaints. 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 full 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:
Some staff had worked at the home for a long time and knew the people who lived there well. The home had enough staff on duty at each shift. People spoken to said the staff team were pleasant and kind, friendly with each other and would do anything to help them. They said staff always knocked on doors before going in to their bedrooms and always respected their privacy. The home completed assessments on people to check if they were at risk of anything. They wrote these down and made sure staff were aware of them. The home looked after people with quite complex needs especially those with dementia. The home had a friendly and homely feel and there were lots of different areas for people to sit. It had a large dining area to accommodate everyone. Visitors spoken to said that they were always welcomed to the home and could visit at any time. People who lived at the home stated they liked the meals and drinks provided. They said they had plenty to eat and they always had choices at each meal with fresh fruit and vegetables. The home was reassessed for the Local Authority Gold Standard Award for quality monitoring in May 2005 and had been successful.
Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
The home had questionnaires for visitors to the home, however separate questionnaires were needed for professional visitors such as doctors, social workers and district nurses to make sure that their views were obtained in how the home was run. The care that people required was written down in care plans. They didn’t always make sure that changes in people’s care needs were included and some of the tasks for staff were not clear enough. For example one stated that the person needed assistance with dressing but it didn’t say what that assistance was. Also one person had been admitted to the home six weeks previous but did not have a care plan in place. This was important because staff needed to know exactly what they had to do for each person to meet their needs. One person was admitted from hospital with medication to calm them, however the directions were not clear and the staff needed to make sure they had advice from professionals as to how often it should be given so it was not left to their discretion. Some of the bedrooms examined had dirty denture pots and toothbrushes and untidy wardrobes. One of the wardrobes had damp clothes from a leak a few days before in the bedroom above. These issues were sorted out whilst the Inspector was still there, however the staff needed to make sure they were checked regularly.
Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 Page 7 The environment was improving and the proprietors were aware of all the work still left to do. Some of the sinks in the bedrooms had pipe work that needed to be blocked in and some bedrooms were in need of decoration. A carpet was needed for the corridor in the entrance as it looked very jaded and some new chairs were needed to replace old institutional ones. 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 J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 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 standard(s) 3 and 5 Service users had their needs assessed prior to admission and had the opportunity to visit and have a trial stay before a final decision on permanent residency. EVIDENCE: The manager completed in-house assessments and there was evidence that assessments completed by Care Management were obtained by the home prior to admission. The assessments were important as they provided vital information for the care planning stage. The homes assessment documentation covered all the required points highlighted in the standard. The manager formally wrote to service users or their representatives following assessment stating the homes capacity to meet needs. Staff members and people who lived at the home stated that people had the opportunity to visit Warley House before they decided on permanent residency. The home also offered a respite service and had day care facilities for five people per day. This gave people the opportunity of short stays at the home and introduced them to other service users and staff. Most people spoken to
Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 Page 10 said that family members chose the home for them, or they had known other people who had lived there. The manager confirmed that the first four to six weeks of residency was a trial basis and this could be extended as required. Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 Page 11 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 standard(s) 7, 8, 9 and 11 Service users could be put at risk as the care plans did not consistently reflect changes in needs and have clear tasks for staff. Service users ongoing health care needs and those when they were dying were met in the home. EVIDENCE: The home had care plans in place that had been formulated from assessments. Some changes in need had not been followed through to the care plan stage, for example one person had developed a sore on her foot, which had been treated and had healed but a short term care plan had not been formulated and a preventative plan for similar occurrences was not in place. One service user had been admitted to the home six weeks previous but a care plan had not been formulated. The staff were using the care management care plan. Tasks for staff did not give clear instructions consistently, for example one care plan stated that the service user needed assistance with dressing but did not state what this assistance was. Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 Page 12 Daily recording of the care people received did not always follow through issues to the next shift and it was not always clear exactly what care had been provided. People spoken to stated that their health care needs were met. There was evidence that staff completed daily forms regarding personal care tasks such as bathing and hair care. Although it was detailed on the form it was noted that nail care tended to be missed. The Inspector noted several service users that required more vigilance with nail care and this was discussed with the manager to address. The Inspector noted that behaviour management charts were completed and there was evidence that this recording and monitoring affected care practices in a positive way for one of the service users. Risk assessments were completed for a range of activities. The home completed monthly weights and there was evidence that GP’s, dieticians, district nurses, physiotherapists and occupational therapists had contributed to the care of service users. A log was maintained of professional visitors and instructions to staff. The home had produced a care plan to use when a person is dying. This included all the care they required when nursed in bed during their final days. It covered personal care, pressure area care, nutrition, oral hygiene, pain control, company, professional input, spiritual needs, and support for the family and friends. The home demonstrated their ability to care for people who were dying. They supported a relative to stay overnight and provided a bed for them. They contacted the GP and district nursing services for advice and support and ensured that the person could be nursed at home. Medication management was examined and the home followed procedures well. All medication was stored correctly and records were maintained for each service user. Care needed to be taken when transcribing medication to ensure the full manufacturers instructions. It was noted that a service user had been discharged from hospital with medication to modify their behaviour and this had been prescribed, ‘as required’. The staff must seek professional advice regarding the administration of such medication. Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 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 standard(s) 12 and 15 The home was inconsistent in its provision of activities in order to meet all service users needs, however nutritional needs were met. EVIDENCE: The home had some activities in place but a number of the service users spoken to felt there was not much to do. Staff had completed social needs assessment forms that detailed a list of activities and whether the person required any help with them. This was a start in recognising what service users were capable of participating in and needed to be followed through with a range of activities to suit the identified needs. The manager confirmed that she was in talks with an external group to provide a range of social activities such as pet therapy, reflexology, massage, exercise sessions, aromatherapy and painting. When in place these activities will enhance the social stimulation. Service users spoken to talked of bingo evenings arranged by the receptionist, sing-a-longs, videos and watching TV. Some people had formed small groups and chatted to each other. Some people chose not to join in at all. Staff members stated that a small selection of games, such as skittles, hoopla, memory games and hang man were organised along with movement to music, walks and fun nights. A hymn singing group from All Saints Church visited twice a month and local clergy visited for services and Holy Communion. Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 Page 14 People stated that routines were flexible and staff members respected their wishes. Eight service users were spoken to and all stated the meals were very good. Some people commented on the range of breakfast choices and said they could have hot meals such as bacon if they chose. All stated that alternatives were available and some people said that there was too much to eat. Fresh fruit and vegetables were available and there were plenty of hot and cold drinks throughout the day. Menus were written over four weeks and were subjected to seasonal changes or at service users requests. This enabled people to have choices and to influence the menus to incorporate their favourite dishes. The home catered for special diets such as diabetic, vegetarian and low fat diets. Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 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 standard(s) 16 The home provides an atmosphere whereby people feel able to make complaints and feel confident they will be resolved. EVIDENCE: The homes complaint procedure was clear and displayed in the entrance. It had appropriate timescales for resolution and included contact details of other agencies. The home had a complaint form, which included aspects of the complaint and what action was taken to resolve the issue. Service users spoken to felt able to make any complaints they may have either to the manager, staff members or their families. All stated they did not have any complaints to make and they were satisfied with the care provided. Complaints received since the last inspection had been resolved. Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 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 standard(s) 19, 22 and 26 Slow progress is being made in the refurbishment of the property and when completed this will enhance the quality of life for service users. The lack of attention to cleanliness regarding denture pots and toothbrushes potentially put service users at risk. 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 manager confirmed that the exterior of the property is to be addressed in September with paintwork renewed around windows. Eventually the windows will need replacing. The gutters were still noted to be in need of attention and the manager confirmed this was arranged for the end of August. Refurbishment had started on the interior and several bedrooms and corridors had been redecorated. The new laundry was complete and the room it used to occupy had been refurbished into an office for the manager to enable her
Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 Page 17 space downstairs. However the process appears to be slow with regards the work that needs completing under sinks in service users bedrooms and bathrooms and toilets were still in need of refurbishment. The home had a refurbishment plan with short and long term goals. Some of these were met. Some of the chairs in communal areas were institutionalised in style and were in need of replacement. Three commodes in bedrooms were noted to be very old and some had uneven wooden surfaces with splinters. These were removed on the day of inspection and new ones ordered. A fence had been erected at the side of the building to prevent the area being used as a thoroughfare by the general public and a local community group was assisting the home to renovate the area into a pleasant place for service users to sit. The proprietors had organised an assessment of the building by an occupational therapist to advise on aids that were required. The grab rails that they recommended as a priority had been installed. The home had appropriate moving and handling equipment throughout the home and a lift serviced the two floors. Generally the communal areas of the home were clean and tidy. However, during a tour of the bedrooms the Inspector noticed several unhygienic practices regarding denture pots, toothpaste and toothbrushes and some wardrobes that were in need of tidying. One wardrobe had damp clothes inside that had been affected by a leak in the bedroom above. These areas were addressed whilst the Inspector was still in the building. Audits must be made of bedrooms on a regular basis to check cleanliness issues. The carpet in the entrance way was in need of replacement and the manager confirmed that this was in hand. Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The home provided sufficient numbers of staff on each shift to meet the care needs of service users. EVIDENCE: The home had a staff rota that reflected who was on duty and in what capacity. As well as the manager there were five care staff on duty throughout the day and a day care supervisor. The home employed two waking staff at night with a sleep-in senior care officer. In addition the home had a receptionist and sufficient catering and domestic staff. The manager was currently recruiting a second maintenance person. Staff reported that they were always busy with some mornings more hectic than others. There was a good core group of staff that had worked at the home for several years and they knew the service users well. All expressed that the manager was very supportive. Service users and relatives spoken to stated that staff members were ‘hard working girls’, helpful, friendly and kind and would go out of their way to help. Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 The home monitors the quality of service provided to people living in the home. This results in people having a say about the way the home is managed. EVIDENCE: On 25.5.05 Warley House was awarded ‘Gold’ status from the Local Authority in their Quality Development Scheme. The quality assurance system consisted of questionnaires to service users, relatives and professional visitors to the home. The questionnaires were distributed at different times of the year and the results collated. The home also conducted audits of the services it provided. These included the environment, meals, care files, laundry, medication, supervision and training of staff, fire records, and general hygiene.
Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 Page 20 Action plans were developed to address any shortfalls and the managers contributed to the annual business and development plan, a copy of which was sent to the CSCI. Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 2 x x 3 x x x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 3 x x x x x Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) Requirement The registered person must ensure that service users prescribed behaviour modifying medication on a when required basis have clear guidance for staff regarding administration based on professional advice and input. (previous timescale of 31.1.05 not met) The registered person must ensure that maintenance tasks such as the clearing of guttering and redecoration under sinks are completed. (previous timescale of 28.2.05 not met) The registered person must ensure that all bedrooms have lockable facilities in place. (previous timescale of 30.6.05 not met) The registered person must ensure that the service user admitted six weeks ago has a care plan in place. The registered person must ensure that care plans reflect changes in need and have clear tasks for staff. The registered person must ensure that daily records follow through issues to the next shift Timescale for action From date of inspection 17th Aug 2005 2. 19 23(2)(b) 31st Dec 2005 3. 24 23(2)(l) 31st Dec 2005 4. 7 15 immediate req by 26th Aug 2005 30th Nov 2005 From date of inspection
Page 23 5. 7 15 6. 7 12(1)(a) Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 7. 9 13(2) and give a clear picture of the care provided. The registered person must ensure that when transcribing, the full manufacturers instructions are clear. The registered person must ensure a range of activities is provided to meet all needs. The registered person must replace the old and unusable commodes within the home and audit the remainder to ensure their safety. The registered person must ensure all bedrooms have working light fittings and chest of drawers with handles on. The registered person must ensure bedrooms are audited regulary to address appropriate provision and cleanliness of toiletries and tidy wardrobes. The registered person must ensure that staff support service users with the tidying of their drawers and remove out of date food items. 8. 9. 12 19 12(1)(a)& 16(2)(n) 23(2)(c) 17th Aug 2005 From date of inspection 17th Aug 2005 By 30th Sep 2005 immediate req 17th Aug 2005 31st Aug 2005 From date of inspection 17th Aug 2005 From date of inspection 17th Aug 2005 10. 19 23(2)(c) 11. 26 12(1)(a)& 23(2)(d) 12. 26 13(3) 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 33 Good Practice Recommendations The manager should consider separate questionnaires for professional visitors instead of the same one sent to all visitors to the home. Warley House J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Unit 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
© 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 J54 2881Warley House V246167 17 August 2005 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
