Inspection on 30/04/08 for Warneford House Care Centre

This inspection was carried out on 30th April 2008.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Warneford House Care Centre 27/07/09

Warneford House Care Centre 28/04/09

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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Snydale Care Home

Hawkhills

Larchfield Manor

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Warneford House Care Centre Warneford House Tenter Balk Lane Woodlands Doncaster South Yorkshire DN6 7EE Lead Inspector Marina Warwicker Key Unannounced Inspection 30th April 2008 07:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Warneford House Care Centre Address Warneford House Tenter Balk Lane Woodlands Doncaster South Yorkshire DN6 7EE 01302 337111 01302 337113 warneford.house@ashbourne-homes.co.uk 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) Ashbourne Homes Ltd Catherine Berry Care Home 40 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (25) of places Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. A condition of registration is that the home can provide care for 1 named person to reside at the home at present under 65 years of age. That 4 named residents occupy bedrooms in the part of the home that offers care to people in the Dementia Unit. Once these bedrooms become vacant they are occupied by people who need the right category of care. 15th May 2007 Date of last inspection Brief Description of the Service: Warneford house is a care home situated in a residential area of Adwick-LeStreet and is within a short distance of shops, library and churches. The home comprises of two units. They are Warneford suite and Adwick suite. The Warneford suite provides personal and nursing care for up to 25 older people, whist 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 per week and did not include costs for hairdressing, chiropody, toiletries and personal transport. A statement of purpose was available 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. Warneford House Care Centre DS0000015876.V363753.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 2star. This means that the people who use this service experience good quality outcomes. An inspection of this care home was carried out on Wednesday 30th April 2008 between 7.30 am and 5.15 pm. The staff, the management and the people using the service were not informed of our visit and therefore it was unexpected. Eleven people who use the service and five visitors were consulted on the day. We also spoke with eight staff that were on duty. A further eight people using the service, ten relatives 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. Any comments received after the publication of this report will be shared with the management of the home. We were joined by one of our ‘expert by experience’ between 11 am and 2.30 pm. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. She spoke to people using the service, relatives and the staff in the Warneford suite to get an insight into the quality of life and the standard of care and dignity given to the people, as well as looking at the quality of food and activities where people were involved. We used ‘SOFI’ in the Adwick unit to make sense of the experiences of people with dementia who were unable to provide feedback due to their cognitive or communication impairments. ‘SOFI’ - Short observational framework for inspection is a methodology we use to understand the quality of the experiences of people who are unable to communicate. SOFI helps us assess and understand whether people who use services are receiving good quality care that meets their individual needs. Time was also spent observing and chatting with staff and the people using the service. The management, which included the registered manager, the operations manager and the project manager, were present most of the time. We informed the management of our finding throughout the day, which helped both parties. We were able to have discussions outlining the changes and action to be taken at the end of the final feedback. Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 6 As part of thematic inspection we looked into the safeguarding aspects of the vulnerable adults within this care home. The purpose of a thematic inspection is to provide a national picture of the quality of services in a particular area and identify trends and report on the findings. The premise was inspected, which included bedrooms of people using the service, the communal areas and the service areas such as the kitchen and the laundry. The private areas were accessed with the permission of the people and the staff at the home so that we respected the people’s wishes. Samples of records such as the care plans, staff recruitment 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 service does well: People who may wish to use the services of Warneford House care centre are able to gain the information they need to make an informed decision about the home. The manager of the home admitted people following a care need assessment. As part of the admission process the staff used the assessments from the placing authorities. People said that they had met the manger of the home in their own homes and they were able to visit the home and meet the people living in the home before they decided to move in. The health and personal care that people received was based on their individual needs. The principles of respect, dignity and privacy were put into practice by the staff working at the home. The care plans had been generated from the needs assessments and the staff we interviewed were aware of the personal needs of the people they were looking after. The staff were able to tell us why the person had come into the home, the support they needed and also what family contact they had. Relatives said that the care staff were good at maintaining people’s hygiene and encouraging people to do as much as they could. On the day of our site visit the staff informed us that there was no one with pressure sores at the home. Some of the visiting professionals gave us the following feedback; “A holistic approach is always used, individual care needs are always addressed accordingly.” “Staff at Warneford are fully aware of the referral policy- they will use if necessary but will always ring for advice.” Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 7 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. We witness staff adjusting peoples’ clothing discreetly when they were not been worn correctly. The relatives said that there were no restrictions on visiting. Most people belonged to the local community and the people saw the home as part of their community. We were aware of the 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 gave the staff some scenarios of neglect and abusive situations and asked what they would do. The staff knew the correct procedures and knew how to make the referrals to the local safeguarding adults department. 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. In summing up our expert by experience said,’ The residents seemed happy and were well cared for in appearance. The rapport between staff and residents was excellent and it was quite apparent the staff did enjoy looking after the residents. What has improved since the last inspection? What they could do better: The staffing levels in both the Warneford and Adwick suite must be sufficient to meet the needs of the people living at the home. If the staff were absent without notice there should be a system where by additional staff are sought for the shift and ensure appropriate cover. Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 8 The management need to monitor the deployment of staff against the dependency levels of the people living at the home. The activity programme for people in both units must be improved so it is suitable and specific to the individuals’ needs. The infected linen must be stored appropriately in the laundry. Leaving them around on the floor of sluice is a hazard and may cause the staff to trip over and bring about the spread of infection. The sluice room should be kept clean and tidy to minimise the spread of infection. The management need to supervise the care staff to ensure that they are competent and confident when looking after people with pain and also people who are receiving terminal care. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 9 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 Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 & 5, 6 not applicable People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the 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: Three care plans were checked; two staff and two relatives were consulted. The evidence confirmed that the registered manager of the home admitted people following a care need assessment. As part of the admission process the staff used the assessments from the placing authorities. People said that they had met the manger of the home in their own homes. They were also able to visit the home and meet the people living in the home before they decided to move in. On the day of our site visit there was a planned admission of a person and we witnessed the manager having completed the assessment instructing and Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 11 informing the staff of the person’s needs. We saw the nurse and a carer attending to the person and the visitors, making them comfortable and spending time familiarising them with the layout of the home. We decided not to interview them since it would have been too much for them on the first day at the home. During our tour of the premise we noticed copies of the service user guide in people’s bedrooms. Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10&11 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice by the staff working at the home. Individuals are in the main involved in decisions about their lives, and often take an active role in planning the care and support they receive. EVIDENCE: We spoke with the people, the staff on duty and the visitors. We observed the care delivery, interaction of staff among themselves and with the people. We also checked three care plans to find out whether the people were giving the care stated in the individual care plans. The care staff said that they had access to the care plans but often did not get the time to read them. Two staff said that they got the information from the Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 13 nurses and the other staff on duty. Such comments highlight the need for an effective handover between staff. The care plans had been generated from the needs assessments and the staff we interviewed were aware of the personal needs of the people they were looking after. The staff were able to tell us why the person had come into the home, the support they needed and also what family contact they had. Relatives said that the care staff were good at maintaining people’s hygiene and encouraging people to do as much as they could. One person said, “Letting people do things for themselves take time but it helps the older person maintain their independence. I see staff helping people but not always doing it for them.” On the day of our site visit the staff informed us that there was no one with pressure sores at the home. We observed staff taking people to the toilet before mealtime and encouraging them to mobilise. The care staff told us that they used pressure relieving mattresses and other equipment to prevent people getting sores. Those people who were nursed in bed had the appropriate mattresses and staff regularly turned the people and they maintained records. Two staff said that the people had access to the general practitioner, community psychiatric nurse, dietician and other community professionals. One family member informed us that sometimes staff were reluctant to call the general practitioner and preferred the family to contact the doctors. We discuss this with the manager and the operations manager who were surprised at this comment and said that they would look into this. Some of the visiting professionals gave us the following feedback; “A holistic approach is always used, individual care needs are always addressed accordingly.” “Staff at Warneford are fully aware of the referral policy- they will use if necessary but will always ring for advice.” The above comments were very encouraging about the staff attitude to seeking help and the quality of care delivered to the individuals. On each unit there were arrangements for the management of medication. Records were kept of the medication received from the pharmacy and from individuals when they arrived from their own home. On the Adwick suit the people were unable to self medicate and the nurse administered the medication. During case tracking we noted that a person had been given medication for pain relief. There was no reference to whether the medication had the desired affect on the person. It is important for staff to find out the effectiveness of the treatment and comments on the daily progress so that it Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 14 could be monitored. We discussed this with the nurse during our visit. The nurse agreed to rectify this. 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. We witness staff adjusting peoples’ clothing discreetly when they were not been worn correctly. When we asked staff how they maintained the peoples dignity and respect these were some of the comments we received. “This is their home and I always remember it. If I want to go into next door I knock or ring the bell. So what is different when I go into people’s rooms? You wouldn’t dream of just walking in.” “Most of the residents are local and they liked to be know as they did at home. Some like to be called names not any resemblance to their name. For example someone by the name of Betty may want to be called Rose. I found this quite normal at this home.” One relative said, “The carers are very good when they take the residents to the toilet and when giving them a wash. They keep the door shut and speak quietly to them instead of shouting and letting everyone know what was going on.” During staff interviews they said that when people got letters they only read to those who were unable to manage to read but often knew when the relatives were to visit and they encouraged the family to read the mail to the people. We noticed that the people receiving terminal care were kept clean and comfortable by the staff. The staff made the family members welcome. All the staff on duty knew of those who required total care. During interviews the staff said that they have had experience and some training on caring for those who were dying. But many said that they would like formal training on palliative care. Two relatives made the following comments. “I must say staff have been great. They talk to my X, they come in every two hours at least to check.” “The staff are very busy but they try their best to spend time when residents in are in their rooms. More staff would help. Can you tell the management two care staff are not enough?” Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14&15 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The people who use services are on the whole able to make choices about their life style, and they were unable to receive the support to maintain their life skills. Social, cultural and recreational activities in general did not meet the individual’s preferences, capacity and expectations. EVIDENCE: Our expert by experience and us assessed this outcome area. The people using the service, the staff, the activities co-ordinator and some of the relatives, were consulted. We have also received feedback for the surveys we sent out. Our expert by experience spent time in the Warneford unit and theses were her findings. ‘I felt that the activities were very poor although there was an activity co-ordinator. The activities diary on the notice board did not correspond with what was happening on the day. One relative told me that people did not have enough stimulation and that was one of the reasons why Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 16 the residents slept a lot. The co-ordinator worked from 9 am until 3 pm and this did not fit in with the time when the residents were free. Trips were organised, there was one being arranged to Bridlington in June and a Summer Fayre in the grounds in July and that was all. She went on to say, ‘I had the opportunity to speak with five residents, one relative and two members of the staff, regarding Warneford House. The residents were very positive. One gentleman said “I have never been so happy, I like it very much here and I can please myself”. Another resident said “He was very happy to be looked after and the food was OK” Another lady who has been in the home for 5 years said “It is very nice, but we don’t do anything, the food is very nice”. Speaking to a relative, she said “The staff are very good but the activities listed on the notice board, just do not happen, and the residents do get bored”, she did go on to say that the staff were absolutely wonderful”. I did ask her if she needed to see the manager was she available? and she said “she was, and she knew the complaints procedure”. Without exception the staff were praised by everyone, as being helpful and kind. My observation of the staff helping residents to the tables and to the toilets etc. was very positive, and the residents were treated with the dignity they deserve. The rapport between the staff and residents was excellent.’ We observed the activities co-ordinator spending time in the Adwick unit entertaining a small group of people. He was involved in helping people feed during mealtime. Some of the relatives said that they felt people enjoyed going out into the fresh air for a short time each day and that was what they did soon after lunchtime. We witnessed relatives taking people out in wheelchairs. These were some of the feedback we received, “There should be time set aside for the residents to spend each day with their care worker and this could be spent taking them out for a short time, chatting, playing a game or doing something creative. But when they arrange trips and outings, when the day comes not many want to go.” “ If there are enough staff I know the carers would spend time with the residents. I see them rushing around looking after people’s immediate personal care.” The relatives said that there were no restrictions on visiting. 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. Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 17 Those people who were able to handle their personal finances were encouraged by the staff to do so and their relatives or advocates handled the finances of others. The management and the surveys confirmed this. The management said that they promote mealtime as a positive experience for the people living at the home. Sometimes relatives joined in to make it a social occasion. We were also informed that ‘ Priority Meal times’ were to be introduced from 19th May where all staff participate at mealtime and make it an enjoyable social experience. These were some of the comments by our expert by experience with regards to Warneford unit. ‘The dining room/lounge and another small lounge were well presented. On the tables the cloths and cutlery were clean. I need to point out that on the day of the inspection the Kitchen was having a new floor laid, and because of that the kitchen was not in use, and fish and chips were brought in from a local chip shop, but I must say the residents did seem to enjoy them, and I also had some, and they were very nice. Dessert was tinned fruit salad and cream. Because of the closure of the kitchen and lack of washing up facilities, polythene cups were on the tables with a choice of orange squash, water and milk. I looked at the menu rotas, they were on a four weekly rota, with a very varied selection, and all of the meals were well balanced nutritionally, with plenty of vegetables, fish and meat. Although one of the members of staff did say that teatime menus were not always followed, due to shortage of staff some of the cooked meals in the evening were not available. The residents and relatives did say that the food was very good, and they had no complaints.’ During our interviews with the staff we discovered that there was inadequate kitchen staff cover and that the cook worked long hours. With regards to the teatime menus not being adhered to, we were unable to verify this with the people since they could not remember what they had to eat the previous teatime. Since the kitchen was out of action on the day of our visit it was difficult for us to evidence this. We spoke with the management and they agreed to look into the staffing cover. We have since received a revised staffing rota from the manager. On the Adwick unit there were snacks and drinks available for the people at all times. Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16&18 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. People who use the service are able to express their concerns and have access to a complaints procedure. People are protected from abuse, and their rights are protected by the home’s policies. EVIDENCE: A copy of the complaints procedure was displayed at the reception area of the home. The care staff were aware of what they should do if anyone made a complaint. One person said, “If anyone complaint to me I would try to solve the problem before passing it on to the manager.” Two relatives said that the staff were a good team and like any where there were sometimes misunderstandings and they talk to the staff or the manager. Some comments from the surveys suggested that the management when dealing with complaints blamed the staff instead of taking on the responsibility for the lack of staff allocation on each shift. We gave the staff some scenarios of neglect and abusive situations and asked what they would do. The staff knew the correct procedures and knew how to make the referrals to the local safeguarding adults department. One relative mentioned that the staff always informed them of any incidents or accidents. Another said, “I know they have to record everything these days, but I know that old people tend to bruise very easily when they knock Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 19 themselves. Accidents happen like if they are at home. The staff can’t stop people moving about.” The manager did not have an up to date record of all the complaints. This was due to the complaints being referred to the Responsible Individual who investigates and deals with the complaint on behalf of the home from the company head office. We discussed this with both the manager and the operations manager and agreed that the local management need to receive the results of the investigation and also any action taken as a result. We checked four staff training records and staff had attended safeguarding adults training in the last 12 months. Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19&26 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the 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 arrived at 7.30 am and carried out a tour of the premise with the deputy manager at around 8 am. The home looked clean and felt comfortable. On arrival at the home we found it difficult to find the front door as the signage was not prominent. Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 21 During our tour of the premise we noted that there were some repair work was needed in the general bathrooms. We discussed the issues with the management and they agreed to address them. The sluice was accessed through the dirty side of the laundry room. Two bags of dirty infected laundry were found on the sluice floor and the room was untidy and the floor was dirty. We were informed that keeping the sluice tidy and clean was the jobs of the care staff. We discussed the sighting of the sluice room and the arrangements in place to do the laundry with the management to establish whether they could improve the handling of the infected clothing and cleanliness of the sluice room. These were the findings of our expert by experience. ‘Warneford House has two units, Warneford and Adwick, the inspector asked me to assess the Nursing Unit, i.e. Warneford. This area is fairly light, and there is good access to the gardens, where there is a greenhouse, which is tended by one of the residents. I did notice the Manager’s office was in the Centre of the building in Adwick the EMI unit, and felt this was quite away from reception, and could have been slightly off putting for relatives to visit, but on saying that directions were adequately signposted.’ Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29&30 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The care staff in the main are trained and skilled to carryout their jobs. It is perceived by people using the service, relatives and some of the visiting professionals that the number of staff during each shift is not sufficient to support the people who use the service and promote the smooth running of the service. EVIDENCE: The home was run as two units. The unit where older people lived had a nurse and three care staff looking after 25 people. One person was admitted during the morning thus requiring someone to carryout the admission process and settling the person and relatives into the new environment. We were told that on the Warneford unit, there should have been one nurse and four care staff on duty. But on the morning of our visit there were one nurse and three care staff on duty. On the Adwick unit there were one nurse and three staff on duty looking after fifteen people with dementia. Some of the people on this unit needed constant supervision. However, one of the care staff were moved to work on the Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 23 Warneford unit to make up the numbers leaving the Adwick unit with two care staff. The activities person spent time on this unit helping the staff. We carried out SOFI observation between 11 am and 2 pm. It confirmed that the five people we observed were in a positive state i.e. They appeared contented, happy, comfortable and relaxed. The people engaged with staff, relatives and objects such as soft toys, walking aids and books. The interactions in all cases were positive. During lunchtime the staff spent more time and there was continuous engagement between the people and the relatives or the staff depending on who was assisting them. Our findings also confirmed that without the relatives being around at mealtimes and helping the people on the Adwick unit the staffing level was not sufficient to meet the needs at mealtime. We observed a relative bringing in a large bottle of sauce and explained to the staff that the small sachets of sauce offered by the home was not enough and difficult to open. We saw relatives helping the staff with the cleaning and tidying after the meal. The relatives were encouraged by the staff to join in at the mealtime and they ate with the people using the service. The relatives said that the food served was tasty. During our tour of the premise we spoke with the domiciliary workers, care staff and the kitchen staff. We established that the management needed to look at the staffing cover over the 24 hour period. The staff deployment should reflect the dependency levels of the people living at the home and the times of day where more staff are required to meet the needs of the individuals. Some staff did not have a clear idea of their job roles and expected their tasks to be completed by other workers. These finding were discussed with both the manager and the operations manager. They assured us that this was an area they were to look at and implement changes. To ensure that the people were in safe hands the staff needed to have an update on the people’s condition before they commence their shift. The hand over between staff did not take place in an effective way. The care staff arrived on duty and began their tasks before informed by the nurse in charge of any changes or update on any new admissions. We arrived at the home at 7.20 am and observed day staff arrive and night staff leave. We were informed that the night nurse had handed over to the day nurses. When we inquired how many night staff had been on duty we found out that one of the carers had to leave during the night due to personal reasons and the management did not know about this. Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 24 During our discussions with the management we highlighted the following issues. a) The care staff did not get a handover before starting their shifts. this placed the people at risk. For example if someone had fallen during the night and the staff coming on duty were not informed of the incident they may get this person up and out of bed without checking for any pain, discomfort may put this person at risk of causing further injury. The manager was surprised that the staff had not received handover in the morning. b) The on call management were not informed of a care staff going home during the night shift. The manager was not aware at what time it happened and how long the home was left short of staff during the shift. Our expert by experience made the following comments. ‘On speaking with the two staff members, they both said that they are short staffed, and due to that some of the residents are not having their breakfast until 10.45, and then having to have their lunch at 12.15. One of the problems highlighted was that they are being told to answer the buzzers quicker when they are in the middle of seeing to another resident, and because of this the residents are late in getting dressed etc., Both members of staff said they enjoyed working as a team and looking after the residents, but would appreciate more staff, so that they can give a good level of care.’ We informed the management of this finding on the day. We checked five staff (2 Nurses and 3 carers) recruitment files with the help of the management. These were our findings. We would like to commend the management for the rigorous recruitment. We spoke of staff needing up to date photos and this was to be addressed by the manager immediately. These were some of the feedback from visiting professionals and relatives in referring to the staff competency and attitude when looking after people with dementia. “Individuality is always looked at by the staff.” “ Personal belongings and family memorabilia are encouraged at the home.” “The staff are interested in the background history and pre-morbid personality of residents when planning care.” “Mixing staff who do not have training in challenging behaviour and dementia is not always appropriate. Sometimes this shows in care staff attitude when they are frightened and respond inappropriately.” “There need to be staff who are trained in mental health and dementia in Adwick unit. The staff need to understand the specific needs of people with dementia. A generally caring staff may not be able to cope with the challenges within the dementia unit and the management need to look at this when they do the rotas.” Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 25 We looked at the training programmes and the staff at the home had been offered a variety of training. We also spoke with some of the staff and the relatives. They were of the opinion that staff would benefit by on going support and supervision. Throughout this report people using the service, relatives and the staff have commented about the lack of staff for the amount of care needs required by the people. Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use this service experience good quality outcomes in this area. 31,33,35,36&38 We have made this judgement using a range of evidence including a visit to the service. The management and administration of the home is based on openness and respect. The management to monitor the facilities at the home use the quality assurance systems developed by the company. EVIDENCE: The present registered manager is an experienced care manager at this home and she is familiar with the people using the service and the families. During the day we noted that the manager needed mentorship to help her develop into the new role as the general manager of the home. The operations manger said that she and the project manager were offering this support. Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 27 We asked to view the annual development plan for the home. We were informed that the maintenance person had the information and since he was away we could not see it. We suggested as the manager of the home she should have access to such information. The manager continues to carryout quality monitoring of the care practices, care records and staff supervisions. The five staff files checked there was evidence of staff having had supervision. Three staff said that the manager supported them and she encouraged staff development. The management had carried out several audits and we were informed that the information was analysed and that they took action. One of the action points was using the ‘Nutmeg System’ to organise the meals at the home. ‘Nutmeg UK Limited (www.nutmeg-uk.com) was set up in 1999 to provide nutritional analysis of menus for a range of providers from schools to care homes, nurseries to prisons. Chefs who have gone through the programme are able to plan balanced menus and obtain nutritional analysis of their choices at the touch of a button. Any nutritional imbalances are identified immediately and the menu can be adjusted simply and quickly.’ We were able to confirm that the manager took reasonably practicable measures to protect the health, safety and welfare of the people using the service and the staff with the resources available to her. All four staff we spoke with said that they had attended training on fire safety, health & safety and moving & handling. We not only observed the care practices of staff which confirmed that the staff were competent in the way they looked after the people we also checked the training files of those we spoke to. All the visitors knew the manager and said that she was approachable and was around most of the days. Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 28 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 3 X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 18 Requirement The staffing levels in both the Warneford and Adwick suite must be sufficient to meet the needs of the people living at the home. Previous requirement: 15/07/07 The activity programme for people in both units must be improved so it is suitable and specific to individual’s needs. The bags containing infected linen must be stored appropriately in the laundry. Leaving them around on the floor of sluice is a hazard of tripping by staff and spread of infection. Immediate 30/04/08. Timescale for action 03/06/08 2. OP12 16 03/06/08 3. OP26 13 30/04/08 Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 30 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. Refer to Standard OP11 OP26 Good Practice Recommendations All the care staff should be competent and confident when looking after people with pain and also people who are receiving terminal care. The sluice room should be kept clean and tidy to minimise the spread of infection. Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Warneford House Care Centre DS0000015876.V363753.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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