Inspection on 05/06/06 for Warrens Hall Nursing Home

This inspection was carried out on 5th June 2006.

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

Other inspections for this house

Warrens Hall Nursing Home 23/05/09

Warrens Hall Nursing Home 20/08/08

Warrens Hall Nursing Home 11/06/07

Warrens Hall Nursing Home 07/11/05

Warrens Hall Nursing Home 09/05/05

Warrens Hall Nursing Home 10/01/05

Warrens Hall Nursing Home 14/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Warrens Hall Nursing Home 218 Oakham Road Tividale West Midlands B69 1PY Lead Inspector Mrs Cathy Moore Unannounced Inspection 5th June 2006 08:00 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 Warrens Hall Nursing Home DS0000004853.V297785.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. Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Warrens Hall Nursing Home Address 218 Oakham Road Tividale West Midlands B69 1PY 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) 01384 455202 01384 240068 starrs.p@bupa.com ANS Homes Limited Pauline Starrs Care Home 56 Category(ies) of Old age, not falling within any other category registration, with number (56) of places Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service user identified in the variation report dated 29.7.04 may be accommodated in the category PD(E). This will remain until such time that the service users placement is terminated. 07/11/05 Date of last inspection Brief Description of the Service: Warrens Hall Nursing home is partly purpose built. The original part of the home that served as the original home is a converted farmhouse. This has been added to and converted to provide a 56 bedded home registered to provide nursing care to older people. The home is owned and managed by BUPA who have a number of other home’s in the area. Warrens Hall is close to a golf course and adjacent to riding stables. There are pleasant views from the back of the home of open fields. It offers generous garden space with a courtyard patio area to the rear. The home has car parking space at the front of the home. Resident accommodation is spread over three floors ( This includes Rowley Unit which at the present time is not being used by the home) and has three distinct units known as Rowley, Malvern and Clent. The home offers in total 40 single en-suite bedrooms, 4 single without en-suite facilities and 6 double rooms. The home provides three lounges and two dining rooms. The home has two passenger lifts enabling resident access to all floors. Weekly fee rates for Warrens Hall range from £430 to £600. Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day between 08.00 and 18.00 hours. The inspection was carried out by two inspectors and a pharmacy inspector. The inspection was carried out as the homes’ main ‘ key inspection’ for this year. During the course of the inspection four resident files were examined, this included looking at their assessment of need documentation, care plans, food consumption and fluid intake records. Nine residents, seven staff and three relatives were spoken to. The premises were randomly assessed to include the courtyard, lounges and dining areas, two toilets and two bathrooms, two bedrooms on the ground and two on the first floors, the kitchen and laundry. Medication systems and safety were assessed by a pharmacist employed by the Commission. Health and safety and service documents were examined. Resident questionnaires were sent to the home for completion pre-inspection all but one were completed by white British people, one white Irish. What the service does well: The home is owned and managed by BUPA. This is a large organisation with homes’ nationwide offering local support networks. The home is located in a pleasant residential area, which offers panoramic views to the rear. The manager and a number of staff have been employed at the home for a number of years providing consistency of care. The manager and staff demonstrate commitment to the home and the residents’ in their care. The home has a high rate of care staff who have achieved N.V.Q level 2 or above in care. The home itself is a large detached property. It is homely and welcoming. Staff pleasant and showing respect to the people in their care. Fourteen of the fourteen completed resident questionnaires confirmed that they had been given sufficient information by the home for them to make a decision about the suitability of the home before they were admitted. The home has an open visiting policy and encourages residents’ to retain contact with family and friends. Positive comments were received about the home and staff from residents’, relatives and completed questionnaires sent to the home prior to the inspection for completion. Comments included; “ Mum has settled in very well. Myself and Mum are more than happy with the home and her care”. “ Surroundings and staff are far better at this home compared to previous Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 6 residential homes’. “ It is a good home”. “ I am very happy staying here”. A staff member commented;” Warrens Hall has a relaxed, happy atmosphere. The staff genuinely look after the people, I like my job very much”. A resident also spoken to during the inspection said;” I’m happy here, very. The staff are great, food is excellent, we have a laugh”. What has improved since the last inspection? What they could do better: The home needs to improve record keeping for assessment and admission purposes. Care planning is at times inconsistent and needs to be addressed more thoroughly. Health and personal care requires ‘fine tuning’ to ensure that all residents’ personal and medical care needs are met and that any risk areas are reduced. Medication systems need ‘ fine tuning’ to ensure that residents have their medication safely and to the prescribed frequency and at the proper time. Activity provision needs to be looked at to make sure that all residents’ social and recreational needs are met and that there is enough stimulation. Meals and menus require further exploration to ensure that they meet with resident choice and that nutritional value is enhanced where possible. The home has some decorating needs mainly in corridors and communal areas where paintwork is damaged and décor looks ‘ tired’. Similarly the driveways and front paving need to be ‘ made good’ to ensure the safety of everyone accessing and exiting the home. Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 7 The laundry is small for the size of the home making it difficult to adequately implement infection control processes. Staffing levels and distribution needs to be looked into to ensure that sufficient staff are available to residents’ at all time and that there is sufficient ’quality time’ for staff to sit and listen to the residents’. Staff recruitment and induction processes need further development to ensure that all staff within the home are safe and trained to look after the residents’. The kitchen needs more attention to ensure that it is clean and hygienic at all times. 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. Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Evidence was available to demonstrate that the home makes available a range of information to proposed residents. Contracts and terms and conditions documents need to be updated, assessment of need processes’ are weak. This section ‘Choice of home’ has been assessed overall as being ’adequate’. EVIDENCE: The service has developed a statement of purpose, which sets out the aims and objectives of the home and includes a service user guide. These documents along with the homes’ last inspection report were on display in the front entrance hall. It is positive that 14 of 14 of the completed resident questionnaires received confirmed that they had sufficient about the home to make a decision about its suitability before they were admitted. Eleven of the fourteen completed resident questionnaires confirmed that they have been issued with a contract. However, on examination of files there was no evidence that this document had been issued. A uncompleted contract document was looked at, terms contained in some instances were seen to be unsatisfactory. Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 10 Applications for admission to the home are agreed sometimes without any documentation or incomplete documentation to back this up. There was little evidence to suggest that residents’ had been involved in their assessment of need process. It is positive however, that a written acknowledgement is given to new residents’ confirming that the home can meet their needs. A number of residents confirmed that they or their relatives had visited the home prior to their admission. One resident commented;” Other homes’ were visited but Warrens Hall was the preferred choice”. Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Care planning processes, general health/personal care provision and medication systems require development and improvement to ensure that all of the residents’ needs are met. This section ‘Health and Personal Care’ has been assessed as being ‘ Adequate’. EVIDENCE: A care plan associated with the previous owner company was on file for each resident. These documents are difficult to follow in some areas as the information is fragmented throughout various care plans rather than being in one place. Although some care plans ‘communication’ for example, were seen to be good, improvement and development are needed in other areas especially diabetes care and behaviour management. There was evidence of resident or relative involvement in the care planning process. Residents’ seen generally appeared well cared for in that their nails were clean, Clothing smart and hair tidy. Records did not however, always confirm that full personal care is being given daily. Records were not available to show that residents’ have been asked about their preferences in terms of bath or shower times. Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 12 It is very positive in that 13 of the 14 completed resident questionnaires received confirmed that they Always receive the care and support they need. One relative said; “ She is always kept nice and clean”. It was confirmed by the manager that regular rouine dental checks are not offered to all residents’ on a regular basis. Similarly records were not available to confirm that all residents’ see the chiropidist regularly. Although it is positive that tissue viability and nutritional assesments are used these do not always correspond with other records reflect individuals situations for instance residents who have lost or gained weight. Record keeping in terms of fluid input/output where needed is not always being consistently recorded. This is particularly important where residents have renal impairment or are on dialysis. Concern was raised in that records showed that one resident had ‘not passed urine for some considerable time’, yet there was a delay in informing the doctor. It was noted that one resident has suffered from an infection. However, there was insufficient instruction in place to inform staff of what to look for in case of reaccurence. A concern was raised in that one resident had fairly severe bruising to both of his hands. Although previously the doctor had indicated that the resident may have old age purpura a condition where bruising often is noticed,it could not be explained how the bruising was caused and there was no processes in place to prevent the bruising or monitor its prevelance. 14 of the 14 resident questionnaire responents feel that they Always receive the medical support they need. Comments received included; Dr is called when required. They tend to every medical need straight away. Can not ask for a better service, better than hospital especially in the Sandwell area. Medicine chart seen were clear and well documented. This means there was a record to show that medication prescribed by a doctor for a resident is recorded. Good procedures and checks were in place to make sure that residents’ receive their medication correctly. It was noted that there were a number of prescribed items and preperataions on site that are no longer needed. It was also noted that a resident who was prescribed medication more than four times a day was not always being given their medication. Good practice was observed during the inspection concerning resident and staff interaction. Staff spoke with respect to residents’ and gave them choices. Toilet and bathroom doors were locked when in use. Nursing and medical treatments and assessments are carried out in private. The home has a payphone for resident use. A number of residents’ have their own phones in their bedrooms. One said;” I have got a mobile phone”. There was only limited documentary evidence available to suggest that the prefeered form of address for each resident is determined or that residents’ are asked if they mind that their personal care is being provided by opposite gender staff. It was noted from records that out of three residents only one had written instructions what to do on their death and preferred last wishes. Unfortunatley Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 13 one resident passed away at the time of the inspection. The staff were observed to give time and support to the bereaved relatives. Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Activity and menu/meal provision needs development and improvement. Residents are encouraged to maintain contact with family and friends and are helped to exercise choice. This section has been assessed as being ‘adequate’. EVIDENCE: The home employs two activities co-ordinators who provide activities over a four day period every week. A care plan is produced for each individual residents’ activity needs. Some record is made of activity participation but not all. Feedback generally is the activity provision is not perceived by residents’ to be as positive as it used to be. Out of 14 completed resident questionnaires received 8 confirmed that ‘ There are activities arranged by the home that they can take part in’, 1 confirmed’ Usually’, 2 ‘ Sometimes’ and 2 ‘Never’. Comments received included; “ Sometimes we are just left in the lounge with a video on”. “Would be useful if activities could involve everyone”. One resident who is has complex physical needs said;” There is nothing to do”. A member of staff commented;” They never go out”. One resident was a regular attendee of the bingo session and confirmed that she liked to play bingo. Visiting times are open and flexible the homes’ visiting policy states;’People can visit at any time as long as the resident wishes to have the visitor’. Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 15 Residents’ and relatives spoken to said;” Visiting arrangements are fine, I visit three times a week”. ”Someone from the family visits everyday”. Residents can choose if they want to receive their visitors in the lounge, bedroom or garden area in the spring/summer months. The home has an advocacy policy, however there were no materials available displaying contacts for external advocacy services. Residents’ can bring into the home with them their personal possessions as long as they do not present any fire or other risks. Residents’ rooms viewed held a range of personal belongings ranging from photos and ornaments and televisions. One resident proudly said; “ This is my own chair, I bought it”. The home has a set menu which is available within the home in print which residents’ are mostly able to read, a number due to personal capabilities may have difficulty in reading or understanding it. It was noted from the menu that it is only Fridays when a choice to the main menu is detailed. The manager confirmed however; “ There is a choice everyday”. Feedback from resident questionnaires confirmed that 7 of the 14 respondents ‘liked the meals at the home’, 7 ‘Usually’ did. One resident did say;” Could do with some variation”. Another resident complimented the food by saying;” The food is excellent”. Food stocks and kitchen staff were spoken to about the quality of food and its nutritional content. Food stocks were plentiful, varied and of a good quality with fresh fruit and vegetables. Fruit seen included apples, bananas and strawberries. A homemade sponge cake had been prepared for tea and a trifle. It was noted that no additional fruit had been added to the trifle to enhance the residents’ daily fruit intake. Similarly it was identified that residents’ requiring a ‘soft diet’ were often given instant mash potato rather then fresh mashed potato. Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Policies, procedures and areas of protection need further work and attention to ensure that all residents’ are safeguarded at all times. This section is assessed as being; ’Poor’. EVIDENCE: The home has a written complaints procedure which is included in the homes’ statement of purpose. It is produced in print only which may limit the understanding of some residents. Resident responses to the question Do you know how to make a complaint? were as follows; 10 of 14 always. 2 of 14 Usually. 1 of 14 sometimes. Questionnaire responses to the question Do you know who to speak to if you are not happy? were positive in that 13 of 14 answered Always. One resident commented; Matron is usually available or sister. Two complaints have been received and logged by the home since the last inspection (and since the new organisation had taken over the home). One was investigated within a 28 day timescale as per the organisations policy guidance. It was not fully detailed however, maybe due to evidence or lack of if the complaint was substantiated or otherwise. Further, the manager said; ”The complainant has told me verbally that she is satisfied with my actions”, rather than the complainant being asked to confirm her satisfaction in writing. The second complaint was assessed by the manager as being more of a protection issue and was referred appropriately as such. One concern has been raised by a relative in that in his opinion his complaint had not been investigated within the timescale set and that he felt that he had not received in writing a full written account of his complaint investigation outcome. This complaint was not detailed in the complaints log as it should have been so it Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 17 was difficult to track and make a judgement on. The manager did confirm that she is fully aware that all complaints must be responded to within 28 days of receipt. The home has a number of policies and procedures aimed to protect vulnerable adults. These policies were mostly seen to be dated prior to 2002, the onset on the Care Standards Act and the Protection Of Vulnerable Adults list in 2004. They did not all reference current guidance as per Sandwell Councils’ Multiagency Adult Protection procedures or the need for incidents to be reported to the Commission in accordance with Regulation 37. One senior nurse has received abuse awareness training to cascade to other staff. However, records show that to date a number of staff have not received this training. The home has been the subject of at least three Vulnerable Adult meetings since the last inspection and a considerable number previous to this. It is therefore vital that staff are informed of definitions of abuse and receive training to prevent instances occurring. It must be said however, that the majority of instances have been reported by the manager as they should through multi-agency processes and to the Commission. Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,24,26 Generally the home is comfortable and has satisfactory access. Communal space both internally and externally is sufficient and accessible by ramp usage. The home has some redecorating needs and improvements are needed in the laundry. This section overall has been given a score of ‘Adequate’. EVIDENCE: The home as described in the ‘Brief Description’ section is a large detached property that has been previously converted into for it’s present purpose. It is situated in it’s own grounds and surrounded by fields and greenery to the rear. The home has areas that can be used in the spring and summer months by the front door and an attractive courtyard area with established shrubs and plants, tables and chairs. At the present time ‘Rowley Unit’ a 16 bed facility within the home is not being used. This area requires major work. The organisation is at the present time considering a range of options for this unit. The home employs a handyperson who attends to minor decoration and maintenance. Parts of the home were seen to be ‘tired’ these included paintwork in corridors and on doors, toilets, Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 19 bathrooms, the laundry walls and communal space. This confirmed by one resident who commented Could do with a face lift. The manager said;” We will soon have the new fire alarm fitted after this we are to be re-decorated”. Another resident however commented; Surroundings far better at this home compared to previous residential home. The home has ramped access to allow people with poor mobility and wheelchair users to get in and out of the home. It has a range of aids and adaptations internally to aid mobility, independence and safety examples being; passenger lifts, grab rails and assisted bathing/toileting facilities. All bedrooms in use at the present time are single occupancy mostly with ensuite facilities provided. At least four bedrooms were viewed some in more detail than others. These rooms were seen to be comfortable, bright and homely. One resident said; “ My room is really nice. Look this is my own chair”. A relative commented;” she has got a nice room very clean”. It was noted from the case files tracked that not all bedroom audit concerning room satisfaction/fittings and furnishings were fully completed and that residents’ or relatives had not all signed to confirm their satisfaction or otherwise. The laundry is small for the size of the home and needs further consideration to improve it. It was noted that staff do not always wear protective clothing in the laundry and there is only one sink rather than having a dedicated hand wash sink. Washing was seen stored on the laundry floor rather than being in an appropriate laundry skip. The home lacks information and policy concerning certain hospital and community acquired infections. A comment was received before the inspection on a resident questionnaire as follows; The smell on entry to the home needs to be dealt with. Neither of the two inspectors’ conducting this unannounced detected any odour in this area. Mostly positive comments were received from the 14 completed questionnaires concerning the cleanliness of the home; 12 of 14 feel that the home is Always fresh and clean.1 of 14 feel that the home is Usually fresh and clean. 1 of 14 feel that the home is Sometimes fresh and clean. A further comment was; ”As a frequent visitor to the home I find it to be well managed and clean. Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Staffing generally has been assessed as being ‘adequate’, work is required to ensure that staff are distributed effectively, that they are trained and competent to do their jobs. EVIDENCE: The 14 completed questionnaires received confirmed the following; 10 of 14 responded to the question Do the staff listen and act on what you say? as Always, 3 Usually 1 did not answer. One comment received stated; They can sometimes be more interested in talking to one another and ignoring us. 9 of the 14 responded to the question Are the staff available when you need them? as Always. 4 usually and 1 Sometimes. Comments received included; Unavailable mostly when short staffed. They need more staff it is no fun rushing around for them. The manager assured that the staffing levels are adeqaute. She provided evidence that she had assessed staffing levels against the number and dependancy level of residents’ accommodated at that time and that 1362 hours per week are needed as are provided.. Day time staffing hours are provided as follows; One trained nurse and four care staff per floor plus the manager during the week. Catering, domestic and laundry staff are also provided. A number of times it was observed that staff were not in lounges with the residents’. The manager confirmed that she would look at staff distribution based on comments received. Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 21 The care staff observed during the inspection were professional, friendly and helpful and were seen to work hard. Positive comments received about staffing included; The staff are caring and attentive. “ Staff are always willing to help if called upon”. “ The sisters are very efficent”. It is positive that 56 of the care staff team have achieved N.V.Q level 3 or above. Staff recruitment processes are in place and have improved over the last 18 months. However, it was noted that there were gaps in the employment history of two new staff which had not been explored and recorded. Further, there was only one written reference on file for one of these staff. In-house induction was available for new staff however, formal induction to the prescribed standards is not yet available to new staff recently appointed. Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 22 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): 31,33,35,36,38. The manager has been approved as a fit person to manage the home, fine tuning of quality assurance and financial process is needed together with some improvement in terms of risk reduction. This section is assessed as being ‘Adequate’. EVIDENCE: The manager has been in post for a number of years and has been approved by the Commission as being ‘a fit person’. She is a first level Registered Nurse and has achieved the Registered Managers Award. One relative commented on a completed questionnaire;” As a frequent visitor to Warrens Hall I fine it well managed”. The organisation has it’s own quality assurance system which is monitored internally. The manager was able to provide evidence of monitoring in some Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 23 areas but not all. To date she has not received the required ’self audit’ framework to enable her to do this. It is positive that questionnaires are used to gain the views of residents and relatives this was confirmed by one relative who said; “ They do use questionnaires but I never bother to fill them out”. Questionnaires are not used at the present time to gain the views of any community stakeholders. It was noted that the Public/ Employers’ liability insurance certificate on display was no longer valid. The home still continues to follow good practice by having individual safekeeping accounts, records and balances. The home holds small amounts of temporary safe keeping monies on behalf of 33 residents’ four of these were checked records and balance against cash which were found to be correct. It was identified however that only one signature was available to confirm transactions where to prevent mistakes and allegations it should be two. One resident’s money is managed by the Local Authority. It was unusual that as this process is in place a relative asks for £75.20 every two weeks. This relative does purchase items on behalf of the resident but does not provide the home with receipts. The manager was able to provide evidence of individual staff supervision processes and accompanying documentation however, these were not all to the required frequency of 6 per year. The manager said that sessions are arranged to rectify this. A new fire alarm system is to be installed in the near future. The engineer is awaiting parts so there is not a confirmed date as yet for this installation. There was evidence available to confirm that the fire alarm and emergency lighting systems have been serviced within the last 12 months. A current gas landlord’s safety certificate was available dated September 2005.The lift was serviced in May 2005 and PAT testing carried out in April 2006. Recommendations were made following the bath hoist service which the manager will confirm have been addressed. It is positive that boiler water temperatures and temperatures from hot water outlets are checked at least monthly. BUPA carried out a health and safety audit in October 2005 and determined that the bedrails used in the home were not suitable and have now purchased and replaced these with new ones. The manager carries out regular audits of accidents to reduce incidents. Jan 2006 there were 6 recorded, Feb 2006, 7 and March 2006, 4. It was noted that the driveways to the home and the block paving at the entrance need remedial work to prevent accidents. The drive has a number of large’ pot holes’, the block paving in areas has become loose. Cleaning processes in the kitchen require more attention and diligence. There was debris under surfaces and a build up of grease on the deep fat fryer and cooker. Paint is peeling on the ceiling next to the window. Temperature Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 24 recording in the kitchen and other processes such as stock control were satisfactory. Staff in the laundry and kitchen said that they were not aware of risk assessments concerning as examples; the deep fat fryer and rotary iron. Lack of knowledge could place them at risk. Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 25 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 2 2 3 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 2 3 x 3 x 3 x 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 2 3 x 2 Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 26 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 OP2 Regulation 5(1)(b) Requirement The registered person and manager must ensure that all residents’ are issued with a contract ( self- funders’) or terms and conditions document ( PCT or SSD funded). The contract must detail the full fee applicable to each resident deducting any Free Nursing Care contributions. Timescale for action 01/07/06 2 OP3 14(1)(c) The registered person and manager must ensure that it is evidenced that prospective residents’ are involved in their assessment of need process. Where they are not able to sign and have no representative to act on their behalf then this must be detailed on the assessment of need documentation. (Timescale of 09/05/05 and 01/12/05 not met). 05/07/06 Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 27 3 OP3 14(1)(a) 4 OP3 14(1)(a) 14(1)(c) 14(1)(a) 5 OP5 6 OP7 15(1) 7 8 OP7 OP8 15(1) 12(1)(a) 12(1)(b) The registered person and manager must ensure that the homes’ assessment of need proforma is fully completed in respect of all prospective residents’. The registered person and manager must arrange a review for (T.H). Outcomes from which must be forwarded to the CSCI. The registered person and manager must ensure that a record is made of any introductory visits to the home. The registered person and manager must ensure that care plans include all needs short and long term goals. The registered person must ensure that diabetic care plans include eye and foot care. The registered person and manager must ensure that full records are made daily to evidence all aspects of care; hair, teeth, nails etc. 05/07/06 05/07/06 05/07/06 05/07/06 05/07/06 05/07/06 9 OP8 13(4) 15(10 The registered person and manager must ensure that all risks are assessed and documented to include control measures for example; aggression, behaviour that challenges the service. The registered person and manager must ensure that nutritional and tissue viability assessment scores reflect changing needs ( not for KJ or FD). This must include current equipment needs for pressure relief. 05/07/06 10 OP8 12(1a)1b) 13(4 15(1 05/07/06 Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 28 11 OP8 12(1)(a) 12(1)(b) The registered person and manager must ensure that; Fluid input and output charts are fully completed and signed. Where it is identified that food/fluid intake charts are needed that these are adhered to. 20/06/06 12 OP8 12(1)(a) (b) 13(4) The registered person and manager must ensure that the doctor is informed if; Residents do not pass sufficient urine. Or there are any concerns or major changes concerning urine output. If residents fluid intake does not meet their required assessed input target. Documentary evidence to show that this has been done and the outcome of such must be available at all times. 20/06/06 Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 29 13 OP8 12(1(a)b) 13(4 13(6 The registered person must ensure that skin bruising prevention is promoted at all times. If bruising occurs the reasons for must be clearly and accurately recorded and monitored. Preventative measures and risk factors must be written into care plans. If bruising occurs and cause is not known then this must be reported to the residents doctor and consideration must be made to informing the CSCI in accordance with Regulation 37. The registered person and manager must ensure that all residents’ are offered on a regular basis dental and chiropody services. That a full record of these offers is made along with refusal of offer. The registered provider and manager must ensure that; Where pain relief and other medications is prescribed as ‘ when required’ that these medications are always offered to the resident. (Timescale of 25/11/05 not fully met). 20/06/06 14 OP8 12(1)(a) 12(1)(b) 01/08/06 15 OP9 13(2) 05/07/06 Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 30 16 OP9 13(2) The registered provider and manager must ensure that nursing staff date the opening of all containers. They must also ensure that balances from previous cycles are carried over. (Timescale of 01/12/06 not fully met). 01/07/06 17 OP9 13(2) 18 OP9 13(2) 19 OP9 13(2) 20 OP10 12(2) 12(4)(a) The registered provider and manager must ensure that medications requiring additional doses are administered to the residents as prescribed by the clinician. The registered provider and manager must ensure that medication audit can be completed. The date of opening of all medication containers must be recorded with balanced carried over to new medication charts. The registered provider and manager must ensure that all medication , dietary supplements and dressings are disposed of when no longer required. The registered person and manager must ensure that; The preferred form of address for each resident is determined and recorded. The preferences of residents is determined in respect of their personal care being provided by opposite gender staff. These must be honoured wherever possible. 01/07/06 01/07/06 01/07/06 10/07/06 Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 31 21 OP11 12(4)(b) 22 OP12 16(2)(m) (n) 23 OP12 16(2)(m) (n)17(2) 24 OP12 16(2)(m) (n) 18(1(a) 25 OP14 12(2) 13(6) 26 OP15 12(3) 17(2) The registered person and manager must ensure that the last wishes and after arrangements are determined and recorded for each resident. This should be done wherever possible during the assessment of need process/ on admission. The registered person and manager must conduct a documented audit of preferences and capabilities concerning activity provision from which a new activities programme must be devised. The registered person and manager must record all activity participation of both spontaneous and planned activities and refusal to participate. The registered person and manager must ensure that the activity providers are trained in special need activity provision an example of which being dementia or for non speaking persons. The registered person and manager must obtain and display advocacy information from a range of providers examples being; Sandwell and Dudley Advocacy, Alzheimer’s Society etc. The registered person and manager must ensure that; The correct weeks menus are displayed at all times. Menus are produced in formats appropriate to the residents’. ( large print/pictorial). That an alternative to the main meal is always detailed on the menus. 10/07/06 10/07/06 10/07/06 10/07/06 10/07/06 01/07/06 Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 32 27 OP15 12(1(a) (b) 16(2(i) The registered person and manager must ensure that; Fresh fruit and vegetables are provided and added to food wherever possible. Examples being fresh fruit in trifles and jelly. Fresh mash potato to be used rather than processed instant mash potato, which should only be used as a very last result. To enhance soft diets liquidised fruit and vegetables, ‘smoothies’ etc. The registered person and manager must ensure that catering staff receive additional training to enhance the nutritional content of food. 15/06/06 28 OP15 16(2)(i) 18(1)(a) 01/08/06 29 OP15 17(2) 30 OP16 22(2) The registered person and manager must ensure that where there is a need to record residents’ food intake ( dialysis, poor nutritional condition) then an accurate account is made of food intake- how many chips eaten etc. The registered provider and manager must ensure that the complaints procedure is appropriate to the needs of all residents’. 01/07/06 01/08/06 (Timescale of 10/01/06 not met). Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 33 31 OP16 22(3)(4) The registered person and manager must ensure that; All complaints and concerns are recorded in the complaints log. All complaints are investigated within 28 days- the outcome of which to be provided to the complainant. It is clearly detailed in complaint response letters whether the complaint was ‘ substantiated’, partly ‘substantiated’ or not ‘substantiated’. 01/07/06 32 OP18 13(6) The registered person and manager must ensure that all policies and procedures concerning protection are reviewed . Present ones are dated 2002-2003 and do not; Fully comply with Sandwell Councils’ Multi-agency procedures. Do not give instruction to staff to report incidents’ in accordance with Regulation 37. 25/07/06 Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 34 33 OP18 13(6) 34 OP18 13(6) 35 OP19 23(2)(d) The registered persons must ensure that all staff read when reviewed the homes’ and Sandwell Councils’ adult protection/ abuse procedures. The registered person must ensure that all staff who have not to date receive appropriate Adult Abuse awareness training. The new organisation must provide a timescale for the; Redecoration of the ground and first floor corridors. Toilets and bathrooms. Lounge/dining areas. Laundry walls. 30/07/06 01/08/06 10/07/06 36 OP19 23(2)(d) The new organisation must inform the CSCI in writing of their plans to enhance window frames on Rowley unit. ( No firm decisions have been made to date) 01/09/06 37 OP21 23(2) The new organisation must ensure that all bathrooms and toilets throughout the home (This applies to Rowley Unit) are in suitable working order and are provided with the required equipment. (No firm decisions have been made to date). 01/09/06 Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 35 38 OP24 13(4) The registered provider and manager must ensure that all wardrobes are suitably secured to prevent accident or injury. (Timescales of 01/06/05 and 01/12/05 not fully met). 01/07/06 39 OP24 16(2)(c) 40 OP26 13(3) 16(2) The registered person and manager must ensure that the audits of each bedroom are fully completed and the individual residents’ are involved in this process. The new organisation must continue to consider ways of improving the laundry. 01/08/06 01/09/06 41 OP26 13(3) The registered provider and manager must ensure that; Dirty laundry/ laundry is not stored directly on the floor. That staff at all times wear appropriate aprons when dealing with dirty washing. 20/06/06 42 OP26 13(3) The registered person and manager must ensure that; A second sink is provided in the laundry for ‘ hand washing’ purposes only. The sealant around baths and wash hand basin in communal areas is in good order at all times. 01/08/06 Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 36 43 OP26 13(3) The registered person and 20/06/06 manager must ensure that clear written guidance is available to staff at all times on the management and prevention of the spread of Clostridium difficile. A care plan must be in place for each resident that this relates to. 44 OP27 18(1)(a) 45 OP27 18(1)(a) The registered provider and 01/07/06 manager must ensure that the CSCI are informed before Rowley Unit is used about proposed staffing levels. The registered person and 05/07/06 manager must ensure that; Staff are distributed effectively at all times. Staff receive awareness training on listening and responding to residents’. 46 OP29 17(2) 19(2) The registered provider and manager must ensure that; Two written references are obtained and are available for inspection for each staff member. That gaps in employment history are explored and the reasons for are recorded . 12/06/06 Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 37 47 OP30 18(1) (c)(i) The registered person and 01/07/06 manager must ensure that all new care staff receive formal induction/foundation training to ‘ Skills for Care standards’ within the first 6 weeks of appointment. The registered person and manager must ensure that processes are established to gain the views of stakeholders in the community about the home. The registered provider and manager must ensure that two signatures verify any transaction in respect of resident money held in safekeeping. (Timescale of 01/12/06 not met). 01/08/06 48 OP33 24 .49 OP35 16(2)(l) 13(6) 01/07/06 50 OP35 13(6) 17(2) 51 OP35 13(6) 17(2) 52 OP35 25(2)(e) The registered person and manager must ensure that receipts for expenditure of money held by the home in safe keeping are numbered and cross referenced. The registered person and manager must explore the situation whereby a relative has £75 from the residents’ money when this money is managed by the appointeeship unit. A full written account of the outcome of this must be made. The registered person and manager must ensure that a valid employers /public liability certificate is on display within the home at all times. 01/07/06 10/07/06 01/07/06 Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 38 53. OP35 17(2)Sch 4-9,10 The registered provider and manager must ensure that all items brought into the home by residents’ (This to include furniture and electrical items) are recorded on a personal inventory. (Timescale of 23/12/06 not Fully met). 10/07/06 54 OP38 23(4) The registered provider and manager must provide a timescale to the CSCI of when the new fire alarm panel will be installed. The registered person and manager must ensure that; The work needed in respect of the large ‘pot holes’ on the side drive is carried out. The block paving at the front entrance of the home is made safe. The registered person and manager must ensure that all staff are fully aware of risk assessments in place for the following; Spin dryer. Rotary Iron. Deep fat fryer. The registered person must ensure that all staff receive the required mandatory training. 01/07/06 55 OP38 13(4) 23(2)(b) 10/07/06 56 OP38 23(2)(c) 25/06/06 57 OP38 13(4) 18(1)(a) 01/10/06 Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 39 58 OP38 13(3) The registered person and manager must ensure that; The kitchen mop situation is resolved to allow staff to effectively clean under all kitchen work stations, fridges etc. That the peeling paint on the kitchen ceiling is removed and the area re-painted. That all equipment is cleaned thoroughly to prevent a build up of grease. 01/07/06 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 OP2 Good Practice Recommendations The registered person must ensure that the resident contract/ terms and condition documents comply with the Office of Fair Trading guidance; ” Unfair Terms in Care Home Contracts”. oft@eclogistics.co.uk or www.oft.gov.uk Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Warrens Hall Nursing Home DS0000004853.V297785.R01.S.doc Version 5.2 Page 41 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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