Inspection on 28/06/05 for Warrengate Nursing Home

This inspection was carried out on 28th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Warrengate Nursing Home 26/09/06

Warrengate Nursing Home 08/11/05

Warrengate Nursing Home 11/10/04

Warrengate Nursing Home 12/05/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Warrengate Nursing Home 2 The Warren, Kingswood, Surrey, KT20 6PQ Kingswood Surrey KT20 6PQ Lead Inspector Lesley Garrett Unannounced 28 June 2005 09:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Warrengate Nursing Home Address 2 The Warren, Kingswood, Surrey, KT20 6PQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01737 833359 01737 830331 Claremont Care Services Limited 2 The Warren, Kingswood, Surrey, KT20 6PQ Mrs Catherine Mary Blatcher Care home with nursing (N) 36 Category(ies) of Old age, not falling within any other category registration, with number (OP), 36 of places Dementia - over 65 years of age (DE(E)), 9 Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 Of the 36 residents accomodated in the home up to 9 (nine) may fall within the category of DE(E) Date of last inspection 05 November 2004 Brief Description of the Service: Warrengate is a large detached home standing in its own grounds in a residential area on the edge of a private estate in Kingswood just off the A217, swome three and a half miles north of the M25. The grounds to the front of the house provide good parking for visitors and the large gardens are secluded. There is a railway station at the local village about a mile away, where amenities include shops, post office and banking facilities. these can be reached by car or using the homes private mini-bus. The home provides accomodation with nursing for up to thirty-six older people and has provision within this number to support up to nine people with dementia. Internally the rooms are pleasently decorated giving a homely and welcoming feel to the premises. Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six hours and was the first inspection to be undertaken in the Commission for Social Care Inspection year April 2005 to March 2006. Lesley Garrett lead Inspector for the service and Maggie White Regulation Manager carried out this inspection. Mr Rajan registered provider and Cathy Blatcher registered manager were present as representatives for the establishment. Geraldine Yates lead pharmacy inspector came in the afternoon to audit the medications. A full tour of the premises took place and documents inspected included care plans, staff rotas, medication records and staff training records. Three care staff were spoken to, the laundry assistant and service users. The service users will be referred to as residents for the remainder of this report as that is their preferred title. A visit took place in April this year following a complaint that CSCI investigated. The manager had to leave at 1300 to attend training for her registered managers award but the inspectors would like to thank the management and staff for their time, assistance and hospitality. What the service does well: What has improved since the last inspection? The home has introduced a new system for care plans and risk assessments to improve their accountability. Some of the bedrooms have been refurbished and this now completes the bedroom refurbishment. Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 6 What they could do better: 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. Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The manager does pre-admission assessments but the forms are not all completed. EVIDENCE: The manager stated that she does all pre-admission assessments and there is a form that can be used within the new paperwork pack. The Surrey health needs assessment form is also used. Not all of this paper work is complete and therefore some of the residents needs maybe missed if full information is not obtained. A recent new admission to the home has to spend his day in bed, as he requires a special wheelchair. He had been in hospital for eight months and no chair ordered but the manager assured the inspectors that a referral had been made to the wheelchair centre. Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 & 11 The health needs of the residents are met using a new care planning system and multi disciplinary working. A review of medication handling was undertaken by a CSCI pharmacist inspector who found that improvements in the handling of medication had been made but further requirements were made to ensure the home can meet the standard of record keeping. There needs to be a more robust death and dying policy. EVIDENCE: Some residents now have a plan of care, which has improved since the last inspection but unfortunately they have not all been completed and the responsibility for completing this paperwork needs to rest with all trained staff not just the registered manager. The home has a very comprehensive care planning system but it will only work if it is completed and reviewed regularly. Some of the plans are not kept in individual files. The manager stated that as each file is being completed so they are being put into individual files. On the day of the inspection the G.P. visited and she told the inspectors she visited weekly and a registered nurse was doing the round with her. The chiropodist visits every six weeks and the opticians are called when needed. A list is kept on the computer so the home knows who is due an appointment. Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 10 The home also has access to a dietician, speech and language therapist, tissue viability nurse and dentist. The manager stated that some of the individual files contain funeral arrangements but this is not something that is discussed freely. There must be a robust death and dying policy and all conversations well-documented including wishes surrounding resuscitation. Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 15 There is a programme of activities and the chef organises these three days a week. The inspectors sampled lunch. EVIDENCE: The manager stated that there is a programme of activities and this is on the wall in the lounge. The chef organises the activities and this is on Monday, Wednesday and Friday afternoon. The inspectors were told that there had been a garden party at the weekend and children had been invited to that. The gazebo’s were still up in the garden allowing the residents shade when they sit outside. One resident told the inspector that he felt lonely, as there was little to do and no one to talk to, as the staff was always so busy. The home has two lounges, which are also used as dining rooms. The back lounge is used for those residents who required a little more assistance. The inspector visited this room during lunch and found the room to be calm with all but one resident feeding themselves. The carer that was helping in this room said she always encouraged the residents to do as much for themselves as possible. The inspectors ate lunch with the residents in the main lounge. The inspectors found that the vegetables and gravy was put on the tables for the residents to Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 12 help themselves but there was a delay in this being served and they were therefore cold. It was also noted that when a resident asked to be moved into a more comfortable chair when she had finished lunch she was told she would have to wait until all teas and coffees had been served. This was discussed with the provider further who stated he would ensure residents could move from the table if they wished. The inspectors would like to thank the chef for the lunch and the carers who helped to serve them. Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has a complaints process but verbal complaints are not always documented. EVIDENCE: The home has one complaint being investigated by the provider, which is on going, and CSCI are aware of this. The proprietor told the inspectors he had recently received a verbal complaint that was now resolved but there was no documentary evidence of this. The inspector suggested that the proprietor start a compliments and complaints book, in line with good practice, where all events can be documented with the outcomes for complaints easily viewed. The proprietor deals with all complaints himself. Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 Recent bedroom refurbishment has now been completed and the communal areas are now planned for updating. EVIDENCE: All the residents’ bedrooms have now completed the planned refurbishment programme with just a few areas to tidy up. A programme is also in place to replace all the old beds with more practical, hospital style beds, which can be positioned to meet each individual service users needs. The proprietor stated that the next job would be the communal areas but if anything ever needs to be done they just do it. The home has a full time maintenance man. Two domestics are employed Monday to Friday and one at the weekends. The home was neat and tidy and there were no offensive odours in the communal areas or corridors. The home also has a full time laundry assistant. The inspectors were told that they had just purchased two new washing machines but unfortunately on the day of inspection one was out of order and they were waiting for it to be repaired. Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 There was a good skill mix of staff on duty and there was evidence of staff training. EVIDENCE: The inspectors looked at the staff rotas, however it was not possible to know the skill mix of staff on duty, as this was not stated on the rota. The proprietor explained who the different grades were. On the day of inspection there was two registered nurses and five carers and the manager. The proprietor told the inspectors that they still referred to the previous registering authority pre 2002 (East Surrey Health Authority) staffing notice and despite empty beds had not reduced the staffing numbers. The inspectors were then showed the training programmes for the year it included the statutory training and the manager had to leave at 1300, on the day of the inspection, to attend training for her registered managers award. Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Health and safety guidelines are followed. EVIDENCE: The proprietor told the inspectors that all radiators have low surface temperatures therefore do not require covers. All water temperatures in the resident’s bedrooms are tested weekly if the residents are able to turn the taps on otherwise they are checked monthly. The fire alarm is tested weekly and fire training happens every six months. Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x x x x x x 2 Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 18 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 26.5 Regulation 13(3) Requirement PEG feed tubing and feed bottles must not be disposed of in the waste bin but in the clinical waste to control the spread of infection. Complete and accurate records must be kept of all medication administered or not administered, together with the reason for the non administration to residents.( This requirement is carried forward from the inspection of 5th November 2004) In the interest of the welfare of the residents a request was made at the inspection for a General Practitioner to review and clarify the medication for two specific residents. Each resident to have an individual file for their plan of care. Each resident shall have all individual plan documentation fully completed by the end of the month Each resident has their wishes about death and dying and resussitation documented in their individual plans. Timescale for action Immediate 28/6/05 2. 9 13 (2) Immediate 28/6/05 3. 9 12(1)(b) Immediate 28/6/05 4. 5. 7 7 15 15 31/7/05 31/7/05 6. 11.3&11.4 15.1 31/7/05 Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 19 7. 8. 9. 16.3 27 38.2 21(8) 18 12(1)(a) 10. 38.2 13(4)(a) 11. 12. 13. 38.3 38.7 31 12(1)(a) 37 10(1) 14. 9 12(1)(a) All complaints to include verbal complaints received by the home should be documented Rotas must contain the surname and designation. All residents have their own toilletries kept in their own bedroom. Staff should not keep their hair products in the residents bathrooms. Door wedges not to be used on firedoors (the provider had taken delivery of magnetic door restrainers on the day of inspection for fitting that day) All electrical appliances to be PAT tested or disposed of if no longer used. All incidents at the home must be reported to CSCI The registered manager should now be in day clothes and not uniform and start a programme of supervision of all staff to include a keyworker system for the trained staff. Residents must not be left without access to medication prescribed for them by their General Practitioner. SWystems must be in place by the provider to ensure that medication is ordered and received at appropriate times to ensure it is always available to the service. 5/7/05 5/7/05 5/7/05 5/7/05 5/7/05 5/7/05 31/7/05 26/7/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 20 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Warrengate Nursing Home H58 S13367 Warrengate NH V234495 280605 Stage 01.doc Version 1.30 Page 21 - 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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