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Inspection on 08/11/05 for Warrengate Nursing Home

Also see our care home review for Warrengate Nursing Home for more information

This inspection was carried out on 8th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The proprietor Mr Rajan is in daily contact with the home and he stated that whatever the manager requested or that he felt was necessary he will provide. He supports the manager so that she can have time to complete her RMA and to have supernumerary hours.

What has improved since the last inspection?

The home has continued at the same level as the previous inspection. Most of the requirements from the previous inspection have now been actioned.

What the care home could do better:

The registered manager failed to return the pre-inspection questionnaire to the Commission prior to the inspection due to an administrative error. The proprietor told the inspector that they have now changed the system so that post is not left unanswered. The registered manager needs to be more organised so that on announced inspections time is given to the inspector so that the procedure runs smoothly. The registered persons must also ensure that requirements made at inspections are all completely actioned within the given timescale. There are six requirements at the end of the report but the proprietor resolved two of them before the end of the inspection and that was all toiletries were removed from the communal bathrooms and the hoist and scales were removed from the fire exit. The registered manager must ensure that all care plans are kept up to date and all pre-admission assessments take place to ensure that the home receives the correct residents to maintain their registration.

CARE HOMES FOR OLDER PEOPLE Warrengate Nursing Home 2 The Warren Kingswood Surrey KT20 6PQ Lead Inspector Lesley Garrett Announced Inspection 8th November 2005 10:00 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 Warrengate Nursing Home DS0000013367.V264156.R01.S.doc Version 5.0 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. Warrengate Nursing Home DS0000013367.V264156.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Warrengate Nursing Home Address 2 The Warren Kingswood Surrey KT20 6PQ 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) 01737 833359 01737 830331 Claremont Care Services Limited Mrs Catherine Mary Blatcher Care Home 36 Category(ies) of Dementia - over 65 years of age (9), Old age, registration, with number not falling within any other category (36) of places Warrengate Nursing Home DS0000013367.V264156.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of the 36 (thirty-six) service users accomodated in the home up to 9 (nine) persons may fall within the category of Dementia (Older People) DE(E) 28th June 2005 Date of last inspection 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, some 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 home’s private mini bus. The home provides accommodation with nursing for up to thirty-six older people and has provision within this number to support up to nine people with dementia. Warrengate Nursing Home DS0000013367.V264156.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over five hours and was the second inspection to be undertaken in the Commission for Social Care Inspection year April 2005 to March 2006. Lesley Garrett, Lead Inspector for the service, carried out the inspection. Cathy Blatcher, registered manager, Mr Rajan, registered provider and Aisha Akran, registered nurse, represented the establishment. A full tour of the premises took place. The inspector saw most of the residents and spoke with some. A pre-inspection questionnaire and a number of returned ‘comment cards’ were also used to write this report The inspector would like to thank the residents and the staff at Warrengate Nursing Home for their time, assistance and hospitality during this inspection. What the service does well: What has improved since the last inspection? The home has continued at the same level as the previous inspection. Most of the requirements from the previous inspection have now been actioned. Warrengate Nursing Home DS0000013367.V264156.R01.S.doc Version 5.0 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 DS0000013367.V264156.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Warrengate Nursing Home DS0000013367.V264156.R01.S.doc Version 5.0 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 the following standard(s): 3 Residents only move into the home following a full assessment by the registered manager or a registered nurse. EVIDENCE: The manager told the inspector that no resident is admitted to the home unless a pre-admission assessment has been carried out. The inspector sampled some resident files and saw that these assessments had taken place and there was also a recently completed health needs assessment form and assessment and care plans from the case manager where appropriate. It was noted however, that one admission had arrived as an emergency and therefore did not have the necessary documentation. It was discussed with the manager that these admissions should be avoided, as they may not necessarily be able to meet that residents needs when they arrive. This has been made a requirement at the end of the report. Warrengate Nursing Home DS0000013367.V264156.R01.S.doc Version 5.0 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 the following standard(s): 7 & 10 There is an adequate care planning system in place that allows staff the information needed to look after the residents. Privacy at the home is upheld for the residents. EVIDENCE: The inspector sampled some of the resident’s individual files. At the last inspection in June it was noted that they had not all been completed and work still needed to be done to achieve this. Good progress has been made with the individual files but they are still not all complete and not all of them are reviewed monthly. It is required that the manager makes sure that all her registered nurses are involved in this process to ensure the records are accurate and complete. The manager stated that the privacy of the resident is respected at all times. The inspector did witness staff knocking on the resident’s bedroom prior to entering. The home has a telephone that can be taken to the resident’s room if they wish to make or receive calls. Residents can also have a telephone in their room if they wish. Warrengate Nursing Home DS0000013367.V264156.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 13 & 14 Some contact is made with the local community and relatives can visit as they wish. Residents are able to exercise some choice and control over their lives. EVIDENCE: The manager stated that the home does not have any restrictions on the visiting times and that visitors are welcomed to the home. One visitor was there who was visiting her husband at lunchtime and had assisted where necessary with his feeding as he chooses to eat in his room. The inspector noticed positive reaction between the visitor and staff. The visitor stated that her husband was very comfortable but he had only been at the home for a short while. The home has no volunteers and not many community groups visit the home. The manager stated that a local school is visiting the home to sing carols in December. Brownies and Guides have also visited the home. Monthly church services take place and the priest will visit whenever necessary. The manager stated that only one resident handles their own finances otherwise the relatives have the responsibility or a solicitor with power of attorney. Warrengate Nursing Home DS0000013367.V264156.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 18 The home has policies in place and training is provided to safeguard residents from abuse. EVIDENCE: The manager stated that the home has the Surrey Multi Agency Procedures for protecting adults, which is the February 2005 copy. The inspector also saw the homes policy and found that it needs to be bought in line with the Surrey procedure. All staff has received training provided in the home and the manager has attended the Surrey training and cascaded this information to the staff. Warrengate Nursing Home DS0000013367.V264156.R01.S.doc Version 5.0 Page 12 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 the following standard(s): EVIDENCE: All core standards inspected on 28/06/05. Warrengate Nursing Home DS0000013367.V264156.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 The residents are protected by the homes recruitment policy. EVIDENCE: The inspector sampled some recruitment files and found that they all contained the necessary documentation. All had application forms and two references with CRB checks. The registered nurses had their PIN checked and there was evidence of this qualification on file. Warrengate Nursing Home DS0000013367.V264156.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 35 The home has a registered manager and there is some evidence that the views of the residents are sought. The resident’s financial interests are protected by the policies of the home. EVIDENCE: The home has a registered manager who is undertaking her registered managers award and has now completed two units. She has attended periodic training to keep her knowledge current. The manager stated that she had organised a resident survey of all her residents and there was another planned before the end of the year. The results of these surveys should be published so that they are available for the residents, their representatives, families and CSCI. Policies and procedures are in place and are updated regularly these are personalised for the home by the manager then signed and dated. The registered provider told the inspector that there was no need for any resident to have large sums of money as any item purchased is put on their Warrengate Nursing Home DS0000013367.V264156.R01.S.doc Version 5.0 Page 15 monthly bill. The hairdresser and chiropodist will bill each resident or their family directly. All bedrooms have a lockable draw for the residents to keep any valuables. Warrengate Nursing Home DS0000013367.V264156.R01.S.doc Version 5.0 Page 16 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 ENVIRONMENT CHOICE OF HOME Standard No Score 1 2 3 4 5 6 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 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 2 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X X Warrengate Nursing Home DS0000013367.V264156.R01.S.doc Version 5.0 Page 17 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 OP3 Regulation 14 Requirement The registered persons must ensure that all prospective residents have a pre-admission assessment. The registered persons must ensure that all care plans are kept up to date and reviewed regularly. The registered persons must ensure that the wishes of the residents concerning death and dying and resuscitation are documented in the care plans. This requirement has not been completed following the inspection report on 28th June 2005. The registered persons must ensure that the homes vulnerable adult policy is in line with Surrey Multi Agency Procedures. The registered persons must ensure that all residents have their own toiletries and not use the communal ones and they are kept in their bedrooms and all other items kept in a locked cupboard. DS0000013367.V264156.R01.S.doc Timescale for action 15/11/05 2 OP7 15 15/11/05 3 OP11 15 08/12/05 4 OP18 18 08/12/05 5 OP38 12 08/11/05 Warrengate Nursing Home Version 5.0 Page 18 The registered provider dealt with this issue at the time of inspection. 6 OP38 12 The registered persons must ensure that fire exits and fire extinguishers are not obstructed with equipment. The registered provider dealt with this issue at the time of inspection. 08/11/05 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 OP9 Good Practice Recommendations The registered manager should ensure that any medication that is omitted should have the reason clearly documented on the back of the MAR sheet. Warrengate Nursing Home DS0000013367.V264156.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Surrey Area Office 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 DS0000013367.V264156.R01.S.doc Version 5.0 Page 20 - 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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