Inspection on 18/08/09 for Warley House

This inspection was carried out on 18th August 2009.

CQC found this care home to be providing an Adequate service.

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

Other inspections for this house

Warley House 11/07/08

Warley House 12/07/07

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 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Warley House Warley Road Scunthorpe North Lincolnshire DN16 1PL Lead Inspector Kate Emmerson Key Unannounced Inspection 18/08/09 09:30 DS0000002881.V377340.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Warley House DS0000002881.V377340.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 warlhome@globalnet.co.uk 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.V377340.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP and Dementia - Code DE(E) The maximum number of service users who can be accommodated is: 39 11th July 2008 2. Date of last inspection 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 it is on a local bus route. 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. The home charges between £365.15 and £436.45 per week. The home does not now charge third party top-up fees. There are additional costs for hairdressing, private chiropody treatments, toiletries and newspapers/magazines. Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The Inspection took place over one day in August 2009. During the visit we spoke to people living in the home, the manager and area manager, and 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. We 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, how the home monitored the quality of the service it provided and how the home was managed overall. We 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. We observed the way staff spoke to people and supported them and checked out with staff their understanding of how to maintain people’s 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. The home had been requested to complete an Annual Quality Assurance Assessment prior to the inspection. A new manager had started at the home just a month prior to the inspection. 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. Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 6 The home was generally clean and tidy and domestic staff worked hard to maintain cleanliness. All the people spoken to were happy with their rooms and the cleanliness of the home in general. People’s needs were assessed before they went into the home and detailed plans of care were developed. Staff had understanding of individual’s needs and preferences. People said they were satisfied with the overall care provided by the home and the staff. People living in the home said they were offered a good choice of meals and said that they enjoyed the quality of food. Comments included ‘the dinners are very good’ and ‘the food is very good’. Staff were sensitive to peoples needs at meal times and enabled people to make a choice about the food they ate. They took meals plated up to some people so they could see the choices available to them. Complaints were well managed and people were protected from abuse. Allegations had been treated seriously and actions had been taken to protect people. What has improved since the last inspection? What they could do better: Care plans must be more specific in detailing the care requirements of those with pressure sores or at risk of developing them and the care must be monitored and evaluated. This is so that the care provided is effective in minimising the risk of pressure sores. There were very limited activities in the home. Whilst interests were recorded at assessment this information did not influence the activities on offer in the home and this area could be improved. Comments from people living in the home included ‘don’t do any activities, sometimes do cards’, ‘sometimes go out in the garden’, ‘no activities, nothing going on, we used to go out all over and have singers in but that doesn’t happen now. I feel trapped in the four walls. We used to be able to go out for a walk around the grounds but we had more carers then. I would like to go out shopping’. Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 7 The processes for staff to report maintenance issues and for these to be addressed must be improved so that repairs are completed in a timely manner. Records of maintenance must be maintained. This is to ensure that the health, safety and welfare of people living in the home are protected. The gardens were very untidy and should be improved. The management could not provide evidence that staffing was provided to meet minimum guidelines and the staff group was not large enough to provide consistent cover for holidays and sickness. The manager was assisting the carers in daily routines and covering shifts. This may affect the manager’s ability to complete and maintain management tasks in the long term. They must review the staffing levels and numbers of staff employed. They had not made sure that they obtained written references for staff before they started to work in the home. This means that they had not fully explored the staff member’s history to make sure they were fit to work with vulnerable people. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Warley House DS0000002881.V377340.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.V377340.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3, standard six does not apply, as the home does not provide intermediate care. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s needs were assessed. People had been provided with a contract/statement of terms and conditions, which meant that people had full information about the service to be provided. EVIDENCE: Five care files were examined in detail. These evidenced that assessments of need and associated risks were usually completed prior to people being admitted to live in the home and that copies of assessments/care plans completed by care management were obtained. Care plans were developed from these assessments to inform staff of the care required to meet people’s needs. The staff stated that there were always assessments and care plans in Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 10 place and described the information provided to them about people’s needs as ‘very good’. Where people were admitted for day care, care management assessments and care plans had been obtained. The manager was advised to develop their own more detailed care plans and regularly review these to ensure that staff had up to date information required to meet peoples needs. There was evidence in the files to show that the manager had formally written to people or their representatives following assessment to confirm the home was able to meet the needs of the person. There was also evidence that people were issued with a contract or statement of terms and conditions. The home does not accept intermediate care placements so standard six does not apply to this home. Warley House DS0000002881.V377340.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s personal and health care needs were met. However there were some deficiencies in care planning and monitoring of the care provided to ensure that risks to health and welfare were minimised as far as possible. People living in the home felt their privacy and dignity was protected. EVIDENCE: The records of care provided to five people were examined. Care plans for people who lived in the home were in place. Care plans for those attending regular day care had not been developed and this is recommended. Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 12 The care plans were reasonably well developed for peoples personal care needs and identified the care required to maintain independence within their own abilities. Whilst there was a low incidence of pressure sores in the home there were some continued deficiencies in care planning and monitoring of the care provided to ensure that risks were minimised. Although risk assessments had been completed and equipment provided, specific care plans detailing the daily care requirements had still not been completed even where, as in two cases, people had been assessed as being at high risk. Although people were weighed regularly and nutritional risk assessments were completed the evidence from these actions did not inform the care. For example where one person had had weight loss recorded the action taken in response to this had not been recorded, a care plan had not been developed to support their needs and the risk assessment had not been updated. Evaluations of the care plans were evident and were more detailed although these were not consistently completed on a monthly basis. Daily care records allowed for detailed information to be recorded. However some of the records did not describe in sufficient detail the care provided or actions taken and any significant details such as weight loss. There was evidence that some people had signed agreement to their care plans. Some people spoken to knew they had care plans, whilst others had little understanding. The manager should endeavour to involve the person’s representative in the agreement of the care plans in these cases. 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. The manager stated that training had been provided in this area, as recommended at the last inspection, although there was no evidence of this recorded on staff files. Comments included ‘staff treat you with respect’, ‘they respected my choice not to have a male carer’ and ‘they always knock on the door before they come in’. Due to the needs of the people living in the home none of them were administering their own medications. The home uses a Monitored Dosage System for medication and only senior care workers administer medication. The policy and procedure had been further developed as recommended at the last inspection. A medication round was observed and random selections of medication records in relation to receipt, administration, storage and stock control were examined Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 13 and found to be well maintained. Staff observed good infection control techniques during the drug rounds. There were no controlled drugs prescribed to service users. Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All the above standards were assessed. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were enabled to keep in contact with family and friends. They received a healthy and varied diet according to their assessed needs and choices. There was limited access to recreational and social activities. EVIDENCE: The home did not employ an activity coordinator and staff were expected to arrange the activities in the home. However there was little evidence that activities were provided on a regular basis and there was no activities plan in place. The new manager had purchased some board games and cards although these had not been used up to the time of the inspection. One staff member stated that carers were doing activities and they were going to do some fund raising activities. Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 15 Comments from people living in the home included ‘don’t do any activities, sometimes do cards’, ‘sometimes go out in the garden’, ‘no activities, nothing going on, we used to go out all over and have singers in but that doesn’t happen now. I feel trapped in the four walls. We used to be able to go out for a walk around the grounds but we had more carers then. I would like to go out shopping’. One person said ‘I am not bothered about activities I like to stay in my room’. Provision of activities is an outstanding requirement and the management must take action on this or enforcement action may be taken. 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 and likes/dislikes and records contained information about people’s religious observances and social interests. People spoken to said visitors could come at anytime and could be seen in private. The home provided three meals a day and a light supper. Staff were observed offering people choices of meals sometimes by showing them the choices plated up if this was more appropriate for the person due to limits in their ability to communicate. Meals were well presented and available in different portion sizes and seconds were available. There was a very good atmosphere in the dining room. Staff were observed to sit next to people who needed support to eat their meal and support was provided in a sensitive manner. However there were a number of people who required assistance and the manager and area manager assisted the staff. Without this assistance people would have waited for some time to receive their meal. The manager was advised to review staffing levels to ensure that people’s needs could be met in a timely manner. People spoken to say that the home provides a good standard of meals, which people enjoyed. Comments included ‘the dinners are very good’ and ‘the food is very good’. However one person said ‘the food isn’t good, the meat is tough and it has got worse recently’. The manager stated that the cooks had identified this and they had changed suppliers. The manager stated that the menu had been reviewed just prior to the inspection. A suggestion box had been provided to enable people to give their views. The staff said the new menus included homemade soups and cakes. Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A satisfactory complaints procedure was in place and complaint records were now maintained in sufficient detail to evidence that complaints were appropriately managed. People were protected from abuse. EVIDENCE: There had been one complaint about the home made to the Commission since the last inspection carried out in 2008. This related to misuse of peoples money and was referred to the Local Authority and at the time of the inspection was under investigation under safeguarding procedures. Complaint records held by the home had improved with regard to details of the complainant and the actions taken following receipt of the complaint. An annual quality assurance assessment (AQAA) had been completed by the home which stated that they had received four complaints however only three complaints records were held. The area manager stated that the information in the AQAA was incorrect. Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 17 The complaints procedure was displayed in the entrance to the home. Staff spoken to say they had no complaints about the home and felt confident to raise issues of concern. People spoken to who live in the home said they knew who to report concerns or complaints to. They were generally positive about the service they received. 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 management or senior care worker. Examination of a sample of individual staff training records showed staff had been provided with training in safeguarding adults and refresher training had been provided just prior to the inspection. There had been two allegations of financial abuse made to the Responsible Individual and the Commission and these had been referred to the local authority under the safeguarding procedures. Allegations had been treated seriously and actions had been taken to protect people. These allegations were being investigated at the time of the inspection. Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were provided with a clean home and extensive redecoration and refurbishment was being undertaken. Some issues relating to the quality of work of the refurbishment project and general maintenance of the home may put people’s health safety and comfort at risk. EVIDENCE: A tour of the home was completed with the manager. Whilst there was major refurbishment being undertaken for which the providers should be commended, the quality of some of the work was disappointing and basic maintenance tasks were not being completed in a timely manner. For example in newly decorated bedrooms taps were dripping and wardrobe doors had been Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 19 painted but they were unable to be closed. There were many light bulbs throughout the home that required replacement, wall lights in the main lounge had not been replaced following decoration and a first floor bathroom and ground floor toilet required locks fitting. A glass window pane in a fire door had been broken but not replaced and therefore would not have been effective in the event of a fire. (The area manger confirmed this window had been replaced following the inspection). There was no consistent and formal way for staff to report maintenance issues and this must be addressed. Although people living in the home had access to the gardens, the gardens were overgrown and untidy. The home was generally very clean and tidy although one bedroom was very odorous. The manager stated that they had tried various treatments with little success. Some people had furnished their rooms with a range of personal items, to reflect their own individual choice and taste but other rooms were not personalised. The manager had recognised this and some preliminary work had been completed to address this. Some bedroom doors had privacy locks and some of the bedrooms had lockable facilities. 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. Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All the above standards were checked. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management could not provide evidence that staffing was provided to meet minimum guidelines. The staff group was not large enough to provide consistent cover for holidays and sickness. Social care needs were not met and some of peoples daily care needs could not be met in a timely manner without additional support from the management team. This may affect the manager’s ability to complete and maintain management tasks in the long term. Staff were trained and competent although records of induction were not provided. All the required recruitment checks had not been obtained prior to staff starting work at the home. This means that a full history had not been obtained to ensure that the person was fit to work with vulnerable people. EVIDENCE: The area manager of the home stated that the Residential Forum Guidance is used to calculate staffing hours however there was no evidence of this. The home did not have any formal method of determining dependency of residents in line with the residential forum guidance. This means that the management Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 21 could offer no evidence as to how they had determined the staffing levels in the home. The new manager had started to look at the dependency of the residents and the staffing provided. There were some indications that staffing was provided flexibly to provide extra staff to assist people to get up and to cover day care. However the staff member who usually covered the day care hours was on leave and no cover had been provided. Also the lunch period was very busy, people were taken to the dining room up to an hour before lunch and many of the residents required feeding or prompting. The manager and area manager assisted the staff to feed people and give out lunches to ensure that people received their meals in a timely manner. Staff spoken to say there were generally enough staff on duty to enable people’s needs to be met. However they felt that the new twelve hour shifts were affecting staffing levels as it was difficult to get cover when staff were off sick. They said that they were not always getting their days off in order to provide cover. The manager stated that she had had work as a carer to cover some shifts. Whilst this gives her the opportunity to get to know resident’s needs and how the staff work the staff numbers employed should be reviewed to ensure sufficient staff cover is available. Evidence from discussions with residents during the visit confirmed that they were generally satisfied with the care they received. Comments included ‘the staff are very nice they look after me well’ and ‘staff are very good’. However comments also included ‘I feel trapped in the four walls. We used to be able to go out for a walk around the grounds but we had more carers then’, ‘they seem short staffed and busy but I get help quite quickly if I ring the bell’ and ‘a bit short in staff numbers, they haven’t got time to look after people’. Employment records for two staff members appointed since the last inspection were examined. Records were generally in good order and relevant and most of the required checks had been obtained before staff started work. In both cases only one written reference had been obtained rather than the two required. This means that a full history had not been obtained to ensure that the person was fit to work with vulnerable people. The manager stated that they had induction packs which meet Skills for Care Common Induction Standards specification. This included a workbook to record evidence that the induction is completed. However an example of this could not be found at the time of the inspection. There was evidence that new staff had completed training in moving and handling and safeguarding. Examination of a sample of staff records evidenced that mandatory training and service specific training was provided 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. The staff Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 22 confirmed that updates in the mandatory training had been provided since the new manager had started. The home had a National Vocational Qualification training programme for staff. At the last inspection twelve of the twenty-two staff had achieved level 2 or above and the rest were working towards the qualification or were enrolled to on the course. Updates on the number of staff with these qualifications could not be provided by the management at this inspection. Some of the staff were registering for NVQ training on the day of the inspection. Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A new experienced manager manages the home. There had been some improvements in the management of health and safety in the home but there was lack of consistency in checking fire systems and attending to issues identified in fire systems checks which may put people’s health and safety at risk. EVIDENCE: The manager is an experienced registered nurse. She has completed a National Vocational Qualification at level 4 and is registered to complete the registered Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 24 manager’s award. At the time of the inspection she had not completed the process with the Commission to be the registered manager. She had been in position as the manager for a month prior to the inspection and was still familiarising herself with the home and the records. She had had to cover some carer shifts and assist residents in daily routines since her employment and care must be taken that this does not impact on her time to such a degree that her ability to complete management tasks is effected. Staff and residents a like were very positive about the new manager. Comments included ‘very approachable’, ‘very caring and hands on’ and ‘very supportive’. The Annual Quality Assurance Assessment had been returned to us and the information provided in this document was used to inform the inspection process. Some of the information provided in the AQAA including complaints, staff numbers, hours worked and equipment service records when cross referenced to the homes records was not accurate. The management monitored the quality of the service provided through monthly quality audits of processes including medication, accidents and care plans. Surveys had been completed by residents and their families but results had not been collated at the time of the inspection. Information relating to the outcome of the surveys should be published and made available to interested parties. The system for holding money on behalf of the residents was under investigation by the safeguarding team following an allegation of misappropriation of money. As a result of the investigations new processes had been implemented and the records had been regularly audited by the homes management. A random sample of records and the cash held were checked and these balanced. There were a range of policies and procedures in place for health and safety. Safe working practices were 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 the new manager had ensured that refresher training had been provided. Maintenance certificates were in place and up to date for moving and handling equipment within the building. Maintenance certificates were now filed and in good order and equipment had been serviced as due. Accident books were completed appropriately and regular audits of the accidents were completed. Risk assessments were seen regarding moving and handling and daily activities of daily living. Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 25 Records showed that the fire alarm had been checked weekly on a regular basis back to January 2009 except in June when records show it had only been completed once. Maintenance issues relating to fire doors had been recorded back to April 2009 but there was no indication that these had been addressed. This is related to the lack of formal reporting mechanisms for maintenance as highlighted in standard 19. Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 26 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 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 X X X X X x 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 2 x 2 yes Version 5.2 Page 27 Are there any outstanding requirements from the last Warley House DS0000002881.V377340.R01.S.doc 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 OP8 Regulation 13 Requirement Care plans must be more specific in detailing the care requirements of those with pressure sores and the care must be monitored and evaluated so that the care provided is effective in minimising the risk of pressure sores. 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 that are suitable for them. An action plan must be provided to the Commission. (Previous timescale of 30/09/07 and 01/10/08 not met) The processes for staff to report maintenance issues and for these to be addressed must be improved so that repairs are completed in a timely manner. Records of maintenance must be maintained. This is to ensure that the health, safety and welfare of people living in the DS0000002881.V377340.R01.S.doc Timescale for action 01/01/10 2. OP12 16(2) m and n 01/01/10 3 OP19 24 01/12/09 Warley House Version 5.2 Page 28 4 OP26 16(2)(k) 5 OP27 18(1)(a) 6 OP29 19 7 OP38 23(4) home are protected. The home must be kept free from unpleasant odours for the comfort of the residents. (The previous timescale of 01/10/08 was not met) Staffing levels in the home must be reviewed to ensure that Residential forum Guidelines are met. This to make sure that staffing levels meet minimum guidelines for the dependency of the people accommodated in the home. (The previous timescale of 14/09/08 was not met) Two written references must be obtained prior to employment of staff. This is to ensure that staff are fit to work with vulnerable people. The fire alarm systems must be consistently tested on a weekly basis and records to evidence this must be maintained. This is to protect people’s health and safety in the event of a fire. (The previous timescale of 11/07/08 was not met) 01/01/10 01/12/09 01/12/09 01/12/09 Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 29 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 5 Refer to Standard OP8 Good Practice Recommendations Care plan evaluations should be completed monthly and the evidence used to ensure care plans are updated as required. The resident’s representative should be involved in the agreement and signing of the care plans where the resident is not able to be involved in this process. The gardens should be maintained to provide a safe and pleasant area for residents to access. Evidence should be provided that induction to Skills for Care Common Induction Standards specification is provided to all new staff. The outcomes from quality surveys should be published and made available to interested parties. OP8 OP19 OP30 OP33 Warley House DS0000002881.V377340.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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