Inspection on 28/04/09 for Warneford House Care Centre

This inspection was carried out on 28th April 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Warneford House Care Centre 27/07/09

Warneford House Care Centre 30/04/08

Warneford House Care Centre 15/05/07

Warneford House Care Centre 14/10/05

Warneford House Care Centre 12/05/05

Warneford House Care Centre 25/10/04

Warneford House Care Centre 18/05/04

Warneford House Care Centre 11/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Warneford House Care Centre Warneford House Tenter Balk Lane Woodlands Doncaster South Yorkshire DN6 7EE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marina Warwicker     Date: 2 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Warneford House Care Centre Warneford House Tenter Balk Lane Woodlands Doncaster South Yorkshire DN6 7EE 01302337111 01302337113 warneford.house@ashbourne-homes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ashbourne Homes Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care Home with Nursing - Code N, To service users of the following gender: Either, Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places 25, Dementia - Code DE, maximum number of places 15 Date of last inspection Brief description of the care home Warneford house is a care home situated in a residential area of Adwick-Le-Street and is within a short distance of shops, library and churches. The home comprises of two Care Homes for Older People Page 4 of 29 Over 65 0 25 15 0 Brief description of the care home units. They are Warneford suite and Adwick suite. The Warneford suite provides personal and nursing care for up to 25 older people, whilst Adwick suite provides personal and nursing care for up to 15 people with dementia. The home is a horse shoe shaped single storey building with easy access to the patio and garden areas. The fees at the time of this site visit ranged from 390 to 578 GBP per week and did not include costs for hairdressing, chiropody, toiletries and personal transport. A service user guide was available to the visitors to the home which provided information about services on offer at the home and the most recent Commission for Social Care Inspection report was displayed at the reception area for the visitors to read. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. An inspection of this care home was carried out on Tuesday 28th April 2009 between 10am and 5pm. The staff, the management, the people using the service or the visitors were not informed of our visit and therefore it was unexpected. Five people who use the service and seven visitors were consulted on the day. We also Care Homes for Older People Page 6 of 29 spoke with eleven staff that were on duty. A further 15 people using the service, 10 staff and four professionals who came into contact with the people were contacted by post and telephone to obtain their views on the service. Comments received from the surveys have been included in the body of the report. Time was also spent observing and chatting with staff and the people using the service. The management, which included the registered manager and the operations manager were present most of the time. We informed them of our findings throughout the day, which helped both parties to verify and start taking action when it was needed. The premise was inspected, which included bedrooms of people using the service and communal areas. Private areas were accessed with the permission of the people and/or the staff at the home so that we respected the peoples wishes. Samples of records such as the care plans, staff supervision and training files were checked. We would like to thank the people who live at Warneford House, their relatives, the staff who took part and the management for their contribution towards this process. What the care home does well: What has improved since the last inspection? What they could do better: The care plans must be kept under review and they must reflect the changing needs of the people.Therefore people are able to receive appropriate care. People must be provided with chairs which are fit for purpose. This will enable mobility and also help the people to access the communal areas and enjoy social activities. The management should review the policy as to when rooms are to be emptied when there has been a death. At mealtimes there must be adequate numbers of staff available. Therefore people who need help will receive the correct level of support which will result in people receiving good nutrition. The activity programme for people in both units must be improved so it is suitable and specific to individuals needs. A record must be kept of all complaints made including details of investigations and any action taken by the management of the home. So that the people using the service and the people working at the home are protected from harm. Furthermore people could be confident that the management of the home took all complaints seriously, carried out investigations and took appropriate action to prevent them happening again. Staffing numbers must reflect the dependency levels and therefore the needs of the people living at the home. Additional staff must be on duty at the peak times of activities.To ensure people are receiving the appropriate care in a timely manner All staff must be trained and deemed competent when dealing with abuse, neglect and discrimination of those whom they care for.Staff must know whether they have had training on protection of vulnerable adults and know what needed to be done if there was to be an incident of abuse, neglect or discrimination . All staff must be competent to do their jobs. The standard of care at the home must Care Homes for Older People Page 8 of 29 reflect the homes aims and objectives.The staff training needs to be competency based so that they are able to carry out their duties appropriately. There was a lack of accountability within the management team. The management of the home must ensure that the home meets its statement of purpose, its objectives and lead by example. The window restrainers must be fitted to the areas of the home which may be putting people who use the service at risk. Lack of access to the manager should be reviewed so that people are able to visit the manager, raise their concerns and/or give compliments about the service. 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 set out 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. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 who may wish to use the services of Warneford House care centre have the information they need to make an informed decision about the home. Evidence: At the entrance hall there were copies of the service user guide. It outlined the type of service and information useful to people when they visited the home. Three care plans were checked. The evidence confirmed that the people were admitted to the home following a care needs assessment by the placing authority and also by the manager of the home. The staff said that people visited the home before coming into live at the home. Two relatives said that they had visited the home and spoke with the people and the staff before moving the relative to Warneford house. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 health and personal care that people receive is not always based on their individual needs. The staff in general put into practice the principles of respect, dignity and privacy whilst working at the home. Some individuals are involved in decisions about their lives, and they are encouraged by the staff to have an active role in planning the care and support they receive. Evidence: We spoke with the people living at the home, the staff and the visitors. We observed the care delivery, interaction of staff among themselves and with the people. We checked three care plans to find out whether the people were given the care stated in their individual care plans and if the care plan reflected the present needs of the individuals. We also checked when it was last reviewed. These were some examples of our findings. A care plan outlined a person having to be Barrier nursed due to infection. There was no indication as to when the last time this was reviewed and confirmed and the site of Care Homes for Older People Page 12 of 29 Evidence: the infection. During our conversation with staff we were informed that the person was clear of infection now and the information in the care plan was not current. A resident was unable to have his/her hair washed for some months - staff informed us- this is due to the person being unable to sit out or go to the shower room since the person needed a special chair. The staff said that they were waiting for the chair to be purchased in order to move the resident safely out of the bed. However, when we consulted the manager she gave us a different reason as to why the resident had not had the hair washed or sat out of bed. This highlighted the lack of communication and understanding between the different levels of staff with regards to what happens at the home. We noted an unpleasant smell surrounding some residents and when we questioned the care staff they informed us that some residents did have an odour about them and seemed to accept the unpleasant odour. A new deputy manager has been appointed and made responsible for reviewing all the care plans and ensuring that the care plans provide the basis for the care to be delivered and reflects the present needs of the residents. We saw a sample care plan and found it an improvement from the present care records. One relative said, One of the nurses informed me that my Xs heel was sore & discolored and that they were seeking help (from the tissue viability lead) from the community specialist. They got advice and the heel recovered in no time at all. Comment from one professional, The nurses are happy to contact us and ask for help. We have good working relationships with the home. The care staff said that they had access to the care plans but did not get the time to read them. We observed the care staff record in the task sheets as they completed specific activities during the shift. A group of staff said that they got the information about the residents from the nurses at handover and this was very useful especially when they had been off work for a few days. We observed staff taking people to the toilet and encouraging them to mobilise. The care staff told us that they used pressure relieving mattresses and other equipment to prevent people getting sores. During our tour of the premise we saw several examples of this. Those people who were nursed in bed had the appropriate mattresses and staff regularly turned the people and this was evidenced by the records kept in the individuals rooms. Care Homes for Older People Page 13 of 29 Evidence: The nurses on each unit managed the medication. The people living at the home on the day of the site visit were unable to self medicate therefore the nurses administered the medication. The homes process for the request for repeat prescription, review of residents medications, response to pharmacy audits and the medication review by the GP have been reviewed by the deputy manager. We noted that changes have been introduced in the best interest of the people using the service. The staff at the home referred to the people with respect and maintained their dignity whilst delivering personal care on the day of our visit. The relatives said that the carers are very good when they take the residents to the toilet and that the staff spoke to them with respect and were friendly. We noted during conversations with people and from the feedback that some residents were rushed and got ready in the morning by the night staff. The emphasis was on night staff before getting off duty had to get some people ready to help the day carers. This was verified during our visit. The staff said that the night staff only got those residents ready who were awake and wanted to get up and that there was no such agreement as to getting people ready to help the day shift. During staff interviews they said that they have had experience and some training on caring for those who were dying. We have received information with regards to the room of a deceased person being emptied without the family being involved. In the light of such information management need to look into the practice at the home. The staff said that they were to have training on palliative care. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 people who use services are on the whole able to make choices about their life style, and receive support to maintain their life skills. Social, cultural and recreational activities in general did not meet the individuals preferences, capacity and expectations. Evidence: The people using the service, the staff, the activities co coordinator and the relatives, were consulted. We have also included feedback from the surveys. Several relatives told us that people did not have enough stimulation and that was one of the reasons why the residents slept a lot during the day. We received a comment, One person cannot provide activities to all the residents. The present activities person was seen helping with 1:1 activities, we were informed that s/he took people out and also organised group activities. The feedback from residents and staff highlighted the following with regards to activities. The need for the homes own transport mini bus to take people out on short trips on the spur of the moment rather than the organised trips in summer. The need for a co-coordinator who is responsible for organising different types of activities Care Homes for Older People Page 15 of 29 Evidence: and include key workers when carrying out activities and finally offering a variety of activities to include every person. The management were made aware of our findings and they said that they too had identified the need for an organiser. However this has been an ongoing concern and very little progress has been made since the last site visit. The relatives said that there had been some restrictions on entering the home due to the changing of the keypad code and staff refusing to let some relatives have access to the new code. The operations manager was present during this conversation and assured us s/he would look into the incident. Most people belonged to the local community and the people saw the home as part of their community. We sensed a feeling of joint working between the staff at the home and the relatives to achieve the best for the people living at the home especially those who were living in the Adwick unit. We observed people being offered meals and staff offering alternatives. The staff were seen helping people with feeding. We saw relatives helping people with meals whilst visiting. The feedback we received informed us that some relatives not only visited the home to feed their relatives but also fed others who needed help. On some occasions they had helped with laying the table and clearing up. All comments highlighted the lack of staff during mealtimes. In our last site visit we were assured by the management that the home was to introduce a system at mealtimes where all staff would be getting involved and make the mealtimes a social and enjoyable occasion. We saw little evidence of this on the day of our visit. The nurses attended to the people who received therapeutic feeds e.g. PEG Feed. On questioning the care staff as to how often they gave mouth care to the people who were having artificial nutrition, they said that mouth care was given as part of the wash in the mornings. We discussed the need to offer mouth care more often to keep the mouth moist and therefore comfortable for the person and also reduce infection due to cracks and sores because of a dry mouth. The care staff agreed that this was a good idea but this was not the practice at the home.(Reguirement made under previous outcome area.) Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 who use the service are unable to express their concerns to the management due to the lack of visibility. The people have access to a complaints procedure, which is available at the entrance. The home has policies to protect people from abuse and promote their rights. However the staff competency relating to this area need to be monitored. Evidence: A copy of the complaints procedure was displayed at the reception area of the home. The care staff and the visitors said that they were aware of what to do if there was a complaint. These were some comments we received. I have written to the management about my dissatisfaction and never even got an acknowledgment. I wanted to see the manager. It is difficult to get to her office. We need to know the code to get through to the unit where her office is. It is not like we come into the home and see the managers office, we have to go looking for it. When people complain and if we are unable to help because its a management matter we try to tell the management they are not interested. What is the point of complaining we know nothing will get done anyway. One relative suggested that the management were good at blaming the staff instead of taking on the responsibility themselves. If they supervised and supported the staff properly then they will find out the failures. We asked a group of staff whether they have had training on Safeguarding and Protecting vulnerable adults. There was a unanimous No from them. However, the manager said that all staff had received the specific training and had records to evidence. The Care Homes for Older People Page 17 of 29 Evidence: management may need to look at alternative ways of training staff and ensuring their competencies. The manager did not have an up to date record of all the complaints. The record we saw was poor and did not give us the information required by the regulation. There were discussions between the manager, the operations manager and us about the lack of recording of the complaints. This was due to people informing us that they had complained and in some instants written to the manager making a complaint. We highlighted the need to explore ways of ensuring the manager receives all of the hand delivered mail including verbal complaints. The operations manager assured us that s/he would closely monitor and make sure accurate records are kept by the home. The management have made referrals to the Safeguarding Adults Service Department when there had been allegations of abuse at the home. The management have worked with appropriate organisations when investigating and resolving the allegations. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe and comfortable environment, which encourages independence. Evidence: We carried out a tour of the premises with the manager at around 10:30 am. Generally the home looked clean and felt comfortable. Some bedrooms needed redecoration and floor cover needed renewal due to the needs of the people using the bedrooms. During our tour of the premise we noted that some repair work was needed in the general bathrooms. The manager informed us that this was in hand. The maintenance person said that they had a routine programme for renewals and decoration, which was supported by the estate management team. But the staff commented that repairs and renewals took a long time and sometimes several months. We shared this information with the management. The operations manager had a staff meeting, which was scheduled on the day of our visit, and she addressed this with the staff. There was good access to the gardens, where residents and relatives had set some plants. Care Homes for Older People Page 19 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 care staff in the main, are trained and skilled to carry out their jobs. The number of staff during each shift during the last four weeks is seen to be sufficient to support the people who use the service and promote the smooth running of the service. However at peak activity times there is still a problem. Evidence: The home was run as two units. The unit where older people lived had a nurse and three care staff. The unit where people with dementia were nursed, there was one nurse and three care staff on duty. We noted that without the relatives arriving at mealtimes and helping the people on the Adwick unit the staffing level was not sufficient to meet the needs at mealtime. Some relatives said if they arrived at mealtimes they were offered a snack and a drink if they wanted to join in. We spoke with people who spent most days at the home with his/her spouse keeping each other company. They said that the staff were very good, friendly and worked very hard. With the help of the manager we checked three care staff training and supervision files . The training records were up to date. We were able to locate one persons 1:1 supervision record, which had taken place in January this year. The management said that the other two staff had supervision in December 2008 but they were unable to locate the records on the day of our visit. (re: supervision please see Standard 36.) Care Homes for Older People Page 20 of 29 Evidence: The manager informed us that one of the three staff had achieved NVQ Level 2 in care and the other two were in the process of working towards the award. Two staff informed us of the process for recruitment and how they attended induction. These were some of the comments we have received from relatives and staff. The staffing numbers have been much better in the last few weeks. But when staff call in sick there is no bank cover. Those who have worked their full time shifts should not be asked to do extras instead there needs to be a reserve of bank carers which the management use to cover sickness. I get supervision all the time. The senior staff tell me if I am doing anything wrong. I feel well supported by the manager and the others. Cant remember having supervision. The only supervision I can remember is when I did my induction I was supervised until I got my passport. After that I cant remember. The management are good at sending us on training. If I ask the manager that I would like to go on a course she always support me. I like working here. Care Homes for Older People Page 21 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 and administration of the home is based on respect there needs to be accessibility and openness towards the people using the service and the staff. Applications and the validity of the quality assurance systems by the company are brought into question by our findings. Evidence: The present registered manager worked at Warneford house as a care manager prior to taking up the position as manager. She is experienced and is familiar with the people using the service, the staff and the families. We were informed of the appointment of the deputy manager who was to support the manager and work as a care manager for the home. The manager continues to carry out quality monitoring of the care practices, care records and staff supervisions. The management had carried out several audits and we were informed that the information was analysed and that they took action. The operations manager visited the home at least once a month and continues to produce reports. These reports contain interviews with the residents, the relatives, and the staff to form an opinion of the standard of care provided in Care Homes for Older People Page 22 of 29 Evidence: Warneford house. The staff whom we spoke with said that they had attended training on fire safety, health & safety and moving & handling. The training records supported this. Our findings throughout this report (for example ongoing problems with lack of staffing especially at mealtimes, lack of complaint management, people not receiving appropriate stimulation therefore ending up asleep most of the day, lack of cleanliness i.e. help with personal hygiene to promote a good standard of care) questions the effectiveness of the quality assurance systems in place and whether the service is run in the best interest of the people using it. We noticed the bedrooms did not have window restrainers. Warneford house is on one floor and the window openings were sited reasonably high. But the people with dementia if they so wish may attempt to get out by climbing on to the window. There had been incidents of theft by people climbing through the windows, which were left open especially during summertime. Therefore to prevent such incidents reoccurring and to protect the people and promote the health & safety of the people at the home windows in the bedrooms and other areas which could place the people at risk need to be fitted with restrainers. Those people who were able to handle their personal finances were encouraged to do so by the staff. The relatives and or the advocates handled the finances of those who lack capacity. The administrator confirmed this. We checked how the home managed the peoples personal finance. The receipts were entered and records were kept of each transaction and the company regularly audited the balance sheets. We found the records satisfactory. Care Homes for Older People Page 23 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 12 16 The activity programme for 03/06/2008 people in both units must be improved so it is suitable and specific to individuals needs. The staffing levels in both 03/06/2008 the Warneford and Adwick suite must be sufficient to meet the needs of the people living at the home. Previous requirement: 15/07/07 2 27 18 Care Homes for Older People Page 24 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The care plans must be kept 30/06/2009 under review and they must reflect the changing needs of the people. Therefore people are able to receive appropriate care. Some examples are Barrier nursing of a person, Statements of peoples wish to get up and get ready in the morning, mouth care to those receiving artificial feeds. People must be provided with chairs which are fit for purpose. This will enable mobility and also help the person access the communal areas and enjoy social activities. 30/06/2009 2 8 16 3 15 18 At mealtimes there must be 26/06/2009 an adequate number of staff available. Therefore people who need Care Homes for Older People Page 25 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action help will receive the correct level of support. Therefore people are able to receive good nutrition. 4 16 22 A record must be kept of all complaints made including details of investigation and any action taken by the management of the home. So that the people using the service and the people working at the home are protected from harm. Furthermore people could be confident that the management of the home took all complaints seriously, carried out investigations and took appropriate action. 5 18 13 All staff must be trained and 26/06/2009 deemed competent when dealing with abuse, neglect and discrimination of those whom they care for. Staff must know whether they have had training on protection of vulnerable adults and know what needed to be done if there was to be an incident of abuse, neglect or discrimination . 6 27 18 Staffing numbers must reflect the dependency levels and therefore the 26/06/2009 26/06/2009 Care Homes for Older People Page 26 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action needs of the people living at the home. Additional staff must be on duty at the peak times of activities. To ensure people are receiving the appropriate care in a timely manner. 7 30 12 All staff must be competent to do their jobs. The standard of care at the home must reflect the homes aims and objectives. The staff training needs to be competency based so that they are able to carry out their duties appropriately. 8 33 24 An effective QA assurance with quality monitoring system must be in place. So that the management will be able to findout how best they are meeting the aims, objectives and statement of purpose of the home. 9 36 18 Staff must be appropriately supervised and there must be records kept of the supervision. The staff supervision helps the staff to feel supported 26/06/2009 26/06/2009 26/06/2009 Care Homes for Older People Page 27 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action and provides an opportunity to make career progress. It helps the management when auditing the staff skills, development needs and practices. 10 38 12 The window restrainers must 26/06/2009 be fitted to the areas of the home where people with dementia have access to. Therefore preventing people putting themselves at risk. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 11 31 The management should review the policy as to when rooms are to be emptied when there has been a death. Lack of access to the manager should be reviewed so that people are able to raise their concerns and/or give compliments about the service. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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