Inspection on 05/03/07 for WCS - Four Ways

This inspection was carried out on 5th March 2007.

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

WCS - Four Ways 08/03/06

WCS - Four Ways 10/08/05

WCS - Four Ways 15/02/05

WCS - Four Ways 04/08/04

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 WCS - Four Ways Mason Avenue Lillington Leamington Spa Warwickshire CV32 7PE Lead Inspector Sandra Wade Key Unannounced Inspection 5 March 2007 08:35a 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 WCS - Four Ways DS0000004265.V313725.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. WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service WCS - Four Ways Address Mason Avenue Lillington Leamington Spa Warwickshire CV32 7PE 01926 421309 01926 882034 admin@wcsfourways.f9.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Warwickshire Care Services Limited Mrs Pearl Mackey Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Manager must undertake the Registered Managers Award by 30th April 2007 8th March 2006 Date of last inspection Brief Description of the Service: Four Ways is managed by Warwickshire Care Services who have managed the home since it transferred along with a number of other homes providing care from Warwickshire County Council in 1992. Warwickshire Care Services are a voluntary sector organization. Four Ways is registered as a care home providing personal care to older people, including two beds, which are used for respite/short stay. The home also caters for up to eight-day care users from Tuesday to Friday inclusive. Accommodation is over three floors, there is a lounge/dining area upon each floor, 18 bedrooms have en suite facilities. There is a shaft lift to enable residents to access all floors and there is wheelchair access to the garden area. The home is situated in Lillington, which is just outside of Leamington Spa. A regular bus service into Leamington stops nearby. Local amenities such as shops are also located close by. Car parking is provided to the front and side of the building. At the time of this inspection the fees ranged from £345.00 per week to £395. Extra charges over and above the fees are made for hairdressing (from £7.00), chiropody (£12.00), newspapers, toiletries and sometimes for transport. WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key inspection to WCS Fourways for this inspection year. The inspection process consisted of a review of policies and procedures, discussions with the manager, care manager, staff, visitors and residents. It took place between 8.35am and 8.00pm. Randomly selected service users were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (if possible) about their experiences, looking at service user care files and focusing on outcomes. Additional care records were viewed where issues relating to a service users care needed to be confirmed. Records examined during this inspection, in addition to care records, included, staff recruitment records, training records, social activity records, staff duty rotas, health and safety records and medication records. Before the inspection, a random selection of residents, relatives and professional visitors were sent questionnaires to seek their independent views about the home. Comments received are included where appropriate within this report. A pre-inspection questionnaire was received from the home on 27 October 2006; some of the information contained within this document has also been used in assessing actions taken by the home to meet care standards. What the service does well: New service users are made to feel welcome and good systems are in place to make sure service users needs are fully assessed before they move in and staff can make arrangements to meet these needs. A comment card from a relative stated “ we have been very impressed with their care, …. and information in making a “new” resident comfortable and welcome”. Staff spend time collecting information for life histories as well as how residents would like their daily care to be provided so that they can maintain some independence and are involved in how their care is to be given. This includes information on times they like to get up and what drinks they would like and when. Service users are able to bring items of furniture and personal belongings with them to help them to personalise their bedrooms and make them more homely. WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 6 Good arrangements are in place for reviewing service users care plans on a monthly basis and review meetings take place with families to ensure they are involved in the care of their relative and the home can consider any concerns families may have. Where service users have complex needs, the home involves the GP and seek specialist support to help address these. A service user commented “Staff have been very good at arranging GP care when necessary”. The home has a flexible visiting policy and service users are able to receive visits from friends and relatives at times that are convenient to them. There are good systems in place to support quality monitoring in the home. This includes books on each floor to record any suggestions, compliments or concerns. Records showed that these are regularly used and comments are taken seriously and acted upon as appropriate to ensure the contentment and wellbeing of service users. What has improved since the last inspection? Service user meetings have increased in frequency and attendance and are chaired by an advocate so that residents feel at ease to raise any comments or suggestions about their care or the services provided by the home. Menus are now being changed seasonally and the manager reported since the new menus had been introduced there had been less concerns raised by residents about the food. Keyworker photo identification sheets have been produced and are in the process of being distributed to service users so that they know who their main carer is. Management team meetings take place every week so that areas requiring action can be discussed and addressed. This has helped to promote good communication systems so that any matters affecting service users can be dealt with swiftly and effectively. Following a suggestion from a resident about wheelchair access around the garden, work was undertaken to widen the path and new wooden furniture has been purchased to benefit the residents. A gas safety check of the home has been completed to confirm gas appliances are safe. Some improvements in regard to medication have been addressed although others still remain. WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. WCS - Four Ways DS0000004265.V313725.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 WCS - Four Ways DS0000004265.V313725.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 4 assessed. Quality in this outcome area is good. Service users receive an assessment of their needs prior to their admission so the home can decide if their needs can be met although they do not receive written confirmation that the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information contained in service users files confirmed there are appropriate assessment procedures in place for prospective new service users. This included obtaining assessment information and care plans from placing social workers. It was not evident that the home writes to service users following their assessment so that the service user knows the home can meet their needs. WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 assessed. Quality in this outcome area is adequate. Service users have care plans in place but information within these as well as medication records is not always specific to be sure all health care needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans are in place for each service user. Overall the care plans covered a wide range of needs and provided suitable information to aid staff in giving good personal and healthcare support to service users. Review notes were seen on service users’ files as evidence that people’s needs are being periodically reviewed with the involvement of service users, social workers and relatives. Service users spoken to confirmed they liked the home and were looked after well. One person had fallen numerous times in the home. Care records showed that staff had taken various actions to try and identify the reasons for this and to prevent this happening. The home had requested via the GP, the involvement of a Physiotherapist, Community Psychiatric Nurse and Occupational Therapist. WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 11 Record sheets confirmed the ongoing contact with the GP. Staff advised that the GP had recently changed the resident’s medication and this had helped to reduce the number of falls. Records showed that staff were continuing to monitor this resident. Residents with pressure areas were being supported by visits from the District Nurse and records on files showed the dates of visits made. Care files reviewed showed that the home uses a scoring system as part of their assessment and care planning system. For example for physical health a score of 2 means “has a diagnosed condition that does not affect them or is prone to occasional conditions that require monitoring”. It was found that care records were not always clear in identifying what the scoring meant such as what the “diagnosed condition” may be making it difficult to know what it was staff needed to address. In one section a score of 5 had been given to indicate “continence cannot be managed” but in the care plan for continence it stated “staff to prompt service user to use the toilet every 1 – 2 hours” which conflicted with this score. One resident was noted to have Parkinson’s Disease, a care plan had not been devised to show how this presented itself and how staff should provide support. Records showed that this person was prone to falls prior to their admission to the home but the risk assessment on the file had not been completed to ensure staff could monitor and help prevent any further falls. The care plan stated that the resident had not had any falls recently but the daily records showed that the resident had recently rolled out of bed. Body charts were in use within the home which is good practice as any wounds to the body can be documented and monitored. One body chart seen had been completed showing dates pressure wounds to the skin had been identified as well as other wounds. One body chart on a file was blank but daily records stated this person had developed a blister on their leg in February 2007. Daily records are being completed but these do not always show that the care needs identified have been met. Staff should record the actions carried out to meet care needs identified. It was observed during the tour of the home that pressure mats are in use which activate an alarm when service users get out of bed during the night. In one room a rug that had been placed over the top of this had a crease down the middle of it which could be a trip hazard to the resident. Risk assessments had not been completed for the use of these pressure mats which can contravene a person’s privacy. A review of medication was undertaken. Each floor has a medications trolley and a member of staff is allocated to administer medication on each floor. WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 12 Controlled drugs are stored separately and the administration of these is recorded in a controlled drugs register. Generally medication administration records (MARs) are being signed by staff to confirm medications prescribed are being given. However, there were gaps on some records in particular on the 3rd and 4th of March making it difficult to be sure the residents had received the medications prescribed. In one case 112 Tramadol tablets had been prescribed and 86 had been signed for, there were 24 tablets left as opposed to 26 suggesting this person had been given their medication but records had not been signed to confirm this. The amount of Movicol Satchets prescribed, given and remaining did not correspond with the records in place. For example, for one resident 28 had been received, six had been signed as given but there were 23 left suggesting on one occasion the record was signed when the resident did not have one. For one resident the records stated that 15 Movicol satchets had been carried forward from the previous period but there was no evidence of these in the trolley. Eye drops were in the trolley but contained an instruction not to be stored above 25°C, it was not evident the temperature of the trolley or room was being monitored to ensure this. For one person 14 Quinine Sulphate tablets had been prescribed and five had been signed for to say given but there were ten left suggesting on one occasion this person did not receive this. It was evident from checking other boxed medications in use that there were similar errors in regards to numbers remaining against those received and administered. One person had been prescribed Paracetamol tablets with an instruction for one or two to be given. Staff had squashed in “1” or “2” on the records to show how many had been given but it was then difficult to read the signatures confirming it had been given. The home need to devise a protocol whereby it is agreed that staff sign for either one or two and any variations to this are recorded on the back of the MAR. This will enable staff to clearly identify what has been given. Service users felt their privacy and dignity is respected and confirmed that staff usually knocked the door before entering, one resident said they did not always knock but they did not mind. This resident said that staff were good in ensuring they were appropriately covered when giving personal care. A service user who wished to go to the toilet was asked out loud in front of other residents if they wanted to go to the toilet as opposed to managing this discreetly. This does not promote the persons dignity. WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 assessed. Quality in this outcome area is adequate. Service users have access to some social activities but these need to be further expanded to ensure service user social care needs are met. Service users generally enjoy the meals provided and are given choices in regard to how care is delivered to help maintain their independence and wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care files contain a section on personal history information that provides a helpful personal profile about service users’ lives and interests. This information was still in the process of development for one care file viewed. An activity schedule is devised each month and this shows activities such as church service, film night, singing, games afternoon, mobility plus, hairdresser, local shops and bingo. It is evident from the schedule that there is usually an activity organised for five days each week. The range of activities is limited but it was established there is no Activity Organiser employed by the home which means some of these would have to be provided by carers. A Day Care Supervisor is employed who provides activities for the day care visitors and the manager advised that some of the residents from the home do join in. WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 14 On the day of inspection some of the service users took part in a church service during the morning. A comment card received from a relative commented on the efforts made by staff in the home to organise a visit to a garden centre because they knew the resident was interested in gardening. One person spoken to voiced their frustrations that they could not hold a “proper” conversation with many of the residents in the home. The manager confirmed that some of the residents had been diagnosed with dementia. A comment card received by the Commission from a service user said that “efforts are made to allow some socialising”. During the inspection one resident had been provided with a doll which clearly gave them some comfort throughout the day. The manager said she had been undertaking some work on organising a group of volunteers so that they could help support additional activities for the residents. Service users’ relatives are encouraged to visit throughout the day or evening and there are no unnecessary restrictions imposed on their visits. It was evident from the review of care plans that the choices and views of service users had been taken into consideration when planning their care. This included whether they would like a bath or shower, whether they had a specific hot drink before they went to bed and details of specific routines they were used to. At breakfast time residents were given a choice of cereals and also had toast and tea. The cook confirmed that hot breakfasts are provided upon request and service users are asked the day before so the cook knows in advance how many need to be prepared. The main meal consists of two hot choices each day. On the day of inspection this was Shepherds Pie or Vegetable Pie with vegetables followed by lemon meringue pie or chocolate mousse (made for diabetic residents). The cook prepares liquidised meals for those that need them and each item is liquidised separately on the plate to help this look more appetising and appealing. A resident spoken to said the food was “adequate” and confirmed a choice of a cooked breakfast is provided on some days. They said that there was always a good selection of vegetables and it was “all very good”. Another resident said that they liked the food “sometimes” and when asked why this was they said that sometimes alternative options were not always given that they liked. WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 15 Three comment cards were received from service users, it was evident that relatives had supported them where necessary to complete these. Two service users responded that they “always” like the food and a third person stated they liked the food “usually”. A comment was made that the home had been “good at adapting to suit the resident – substituting items they did not like”. The cook said a four weekly menu is in place and all service users had been provided with a copy of this. She said this is changed seasonally as required. Staff complete resident choices each day to provide to the cook and if the service users do not like the two choices on the menu each floor has their own alternative menu. The cook advised this includes jacket potatoes, pasties, egg and chips. At tea time there is usually sandwiches or a hot choice. At teatime one resident said they did not feel like their sandwiches, the other was presented with a meal and did not know what it was, they said they could not remember what it was called. The inspector advised it was corned beef hash, this had been provided with a slice of buttered bread. The resident tasted the corned beef hash and said it had too much mashed potato in it and left it. Both residents were given sponge cake and both asked a member of staff for some jam to put on it . One of these residents also used the jam to spread on the bread they had been given with their tea. One of the residents commented that it was a diabetic sponge. Fridges and freezers in the home were well stocked with food and the cook confirmed she could have daily meat deliveries if she wishes. Each of the kitchenettes had milk and supplies of bread, margarine, jam etc so that snacks and drinks could be provided for residents as required. During the inspection relatives were observed to also use the kitchenette areas to make a drink. WCS - Four Ways DS0000004265.V313725.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is good. Concerns or allegations are taken seriously and are investigated to ensure the protection of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure is in place and is displayed on the wall in the corridor for the benefit service users and visitors and this gives details of who to direct complaints to. Comments, suggestions and complaints books are situated in the hallways on each floor so that service users and visitors can note any comments or concerns and these can be brought to the attention of the manager. It was noted that these books had been well used demonstrating that both service users and visitors feel at ease making any concerns known to staff as well as compliments. Items listed included comments about the food and cleanliness of the home. A complaints log is also in place for recording and tracking formal complaints made about the home. It was evident that any complaints or concerns made had been followed up and the findings of investigations recorded. Since the last inspection there has been one adult protection issue which was linked to the security of money kept in the home. The home have policies and procedures in place to deal with allegations made and it was evident that the manager had taken appropriate actions to investigate this matter and take WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 17 actions to prevent this matter from reoccurring. This has included the provision of lockable facilities in rooms. Appropriate parties had been informed including families. Training information available in the home shows that Abuse training is being provided on an ongoing basis and staff spoken to were aware of types of abuse and what they should do in regard to reporting this. WCS - Four Ways DS0000004265.V313725.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed. Quality in this outcome area is adequate. Generally the home is well maintained but there is some attention to décor required as well as the cleanliness of the home to ensure service users are cared for in a safe and comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is generally well maintained and has a combined lounge/dining area on each floor and a kitchenette. Residents all stated they were happy with their rooms and those rooms viewed had been personalised with pictures, ornaments etc to make them more homely. The cleanliness of rooms varied around the home, some were very clean and had new carpets and others were dusty and had carpets that needed hoovering. Some of the rooms had thin sheets on the base of the beds and had discoloured as part of the washing process and others had sheets in good condition. WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 19 Dining areas were made to look attractive with tablecloths, mats and napkins and a service user on one floor commented on how nice the dining area looked. Kitchenettes were viewed on each floor and cupboards were found to be in need of cleaning due to crumbs and food debris. Microwaves viewed on two floors were dirty and in need of cleaning. The grouting around the sink areas had gone black and was in need of replacement and on one floor the paint had worn around the tiles making it difficult to clean. The plastic containers which cereals were stored in were in need of cleaning. Carpets around the communal areas were stained or marked and looked in need of a deep clean. In regard to infection control practices. The home has a sluice room on each floor to clean and empty commode and undertake any sluicing procedures which is good practice. There were no hand wash sinks, soap or paper towels in these areas for staff to use although gloves and disposable aprons were available. Staff said that they washed their hands in the nearby toilets. In one bedroom the door was open and a commode chair had been left with no lid and the commode pot had been used and also had no lid. This is poor infection control practice. All commodes should have lids so they can be transported safely to be emptied and washed. In the first floor bathroom bars of soap were seen which suggests these could be used communally for residents. This does not support good infection control practice. Each resident should have their own toiletries which are labelled where possible and returned to their rooms following use. The shelf in this bathroom was worn and not sealed making it hard to effectively clean. The tray on the bath was dirty and in need of cleaning. A toilet on the top floor had a dirty toilet seat and pan and was in need of cleaning. The laundry has two washing machines and one tumble drier to cater for 44 residents. One of the washing machines is smaller than the other and it was established this had not been working effectively which has affected the laundry service. Although the one tumble drier in place has a large capacity, as there is only one, this also impacts on the amount of laundry that can be processed at any one time. Staff agreed that two tumble driers would help to improve the laundry service but also acknowledged there is limited space in the laundry. WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 20 Systems are in place to ensure any laundry is clearly labelled and there is a rail to store clothes that have been ironed prior to them being taken to the rooms. The layout of the laundry means that dirty laundry coming into the laundry is taken past clean ironed items but laundry bags are used to help prevent any possible cross infection. There is a sink in the laundry but it was not clear if this is used for laundry purposes as well as for staff to wash their hands. A dedicated hand wash sink should be available for staff preferably with a soap dispenser and paper towel dispenser. There were no paper towels for staff to dry their hands although liquid soap was available. The Housekeeper said that laundry staff wear tabards and gloves are provided to maintain good infection control practices. WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 were assessed. Quality in this outcome area is good. Sufficiently trained staff are available to meet the needs of the service users and systems are in place to ensure staff are not recruited until all checks have been completed to safeguard service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager confirmed that they aim to provide two care staff on each floor during the day and there is a total of three care staff during the night. There are dedicated staff to undertake cleaning, catering and the laundry for the home. Both the manager and care manager work in a supernumerary capacity. There is a notice board in the entrance hall of the home that shows who is in charge each day so that any visitors know who to speak to if they have any queries or concerns. The manager advised that a kitchen assistant comes in each day at 7am to provide residents with drink prior to staff getting them up for breakfast. Duty rotas confirmed this and residents spoken to all confirmed they had been provided with a drink on waking. WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 22 Duty rotas show that care staff are allocated to each floor but when staff changes occur these are documented on the “handover attendance record” as opposed the duty rota so both documents have to be used to get an accurate picture of the staffing for the home. The manager was advised to ensure that the duty rota accurately reflects the movement of people in the home so that it is clear what staff are available and who is supporting each floor. The handover attendance sheet shows that the staffing numbers the home aim to achieve are being met most of the time to ensure there are sufficient numbers of staff to meet the needs of the service users. Of the three comment cards received by the Commission from residents, two said that staff were “always” available and one person said “usually”. A relative commented “we have been very impressed with their care, concern and information in making a new resident comfortable and welcome”. Another relative commented “I think my relative is glad of the regular and consistent staffing”. The manager confirmed that 34 care staff are employed at the home and at the time of this inspection 18 of these had achieved a National Vocational Qualification (NVQ) II in Care. Three staff were nearing completion of this to help them provide more effective care to the residents. This demonstrates that the home is exceeding the standard of 50 of care staff to achieve this qualification. Detailed induction training is available for new staff which is carried out over several weeks to allow them to build up competencies in areas of care and services as appropriate. At the time of this inspection some of the staff were still to commence this training. Statutory training is organised on an ongoing basis and records on display in the Care Managers office show training completed by staff. The manager advised that all statutory training was up-to-date with the exception of moving and handling updates which she was in the process of organising. The manager confirmed there were sufficient numbers of staff trained in first aid to ensure a first aider could be on duty at all times. A review of staff files was undertaken to confirm recruitment practices carried out. All of the required information had been obtained prior to recruiting staff to ensure staff had been deemed safe to work with the residents. This included written references, criminal record bureau checks (CRB), protection of vulnerable adult (POVA) checks and suitable identification. WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 37 and 38 were assessed. Quality in this outcome area is adequate. The home is managed by a person of good character and quality monitoring systems are in place to ensure the home is run in the best interests of service users. Some attention to health and safety matters is required to fully safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of this home has been in post for 2.5 years and worked as the Care Manager of the home prior to this. The manager advised she was currently working towards achieving the Registered Managers Award and was hopeful to complete this by the end of April 2007 as required. To ensure the home is run in the best interest of the service users there has been several quality monitoring systems implemented. This includes meetings WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 24 with service users which are attended by the manager as well as a person from Advocacy Alliance who takes the notes of the meeting and raises any issues with the manager on the behalf of service users. The notes of the last meeting which was held in February showed that service users were asked for their ideas on activities and were advised of the homes intention to have a relative volunteer group. At the request of residents the manager had also devised a system whereby residents could more easily identify their keyworker. Photographs had been taken of all staff and it was planned to put these on the inside of each service users door as a reminder of the support available to them. Actions carried out from the previous meeting had been recorded on the notes so that residents knew their suggestions had been listened to and acted upon as appropriate. In addition to service user meetings, each month as part of the care plan reviews, service users are asked a question about how they feel about their care or services provided. Their response is recorded on their file and the manager monitors all responses so that any actions necessary can be carried out. Quality assurance systems in regard to housekeeping and catering are in the process of being started. The manager said that a formal meeting is held with relatives on an annual basis which includes a question and answer session. Notes of this meeting are kept but were not available during this inspection. The manager agreed to forward these to the inspector for review. Two comment cards from health and social care professionals confirmed that they were satisfied with the overall care and service being provided. The manager advised that the Registered Provider is visiting the home on a monthly basis. A copy of the report of these visits was requested but was not available. It was not evident that the Registered Provider is producing reports following visits to the home to comply with Regulation 26 as required. This has been an outstanding issue since 30 April 2005 and despite extended deadlines has still not been addressed. Reports must be completed to show an inspection of the premises has been undertaken as well as discussions with staff, visitors and service users as appropriate. A review of service user pocket monies was carried out to ensure this is being managed safely and accurately. Suitable facilities are available for the storage of money and there is restricted access to this by staff. Transactions carried out by service users are being recorded as well as any money into WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 25 accounts provided by relatives or resident representatives. Receipts were available for transactions made although a receipt provided for several residents for labels did not make clear who these were for so that there was clear audit trail. One expenditure record showed a discrepancy of £20.43, the administrator and manager had identified this and were taking actions to investigate this as necessary. The administrator said the account would be credited if the expenditure was not otherwise identified. Health and safety records were reviewed to confirm appropriate checks are being carried out to make the home safe for service users. Records in place confirmed the following:5 Year Electrical check – 5.6.03 Gas check – valid until 31.3.07 – (this was not in the form of a Landlords Gas Certificate and should be pursued with the Gas Contractor as appropriate). Legionella check 6.10.06 Portable electrical appliance testing – 10.3.06 The Housekeeper confirmed the fire alarms are tested weekly. The preinspection questionnaire provided by the home states that the fire equipment was checked in September 2006 and the fire officer visited in the home in March 2006 to undertake an inspection of the premises. No actions are detailed as outstanding following this. The lift was checked in September 2006. Fridges and freezers in the main kitchen were operating at the recommended temperatures to store food safely but the freezers were found to be in need of defrosting. Fridges within the kitchenette areas were generally clean although the cleaning schedules viewed on one unit showed staff were not consistently completing them to confirm cleaning is being carried out on a daily basis. Records also did not show that food temperatures were being monitored on a daily basis to ensure this was safe and suitable for residents. It was evident from the record book that the manager had audited this and had noted the records not completed. This was indicated with a highlighter pen. It was not evident that staff had acknowledged the deficiencies in the records or were taking actions to now address this. In one of the kitchenette fridges there were three eggs which were not dated making it difficult to know when these would need to be disposed of. A packet of biscuits had been opened but not stored in a sealed container to ensure they kept fresh and suitable for residents to eat. Jugs of milk in the fridge and a pot of jam had not been covered. WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 26 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 X X 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 1 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 2 2 WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 27 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 OP4 Regulation 14(1)(d) Requirement The registered manager must write to service users following their assessment to confirm the home can meet their needs. The registered manager must ensure care plans clearly show care needs, how these are to be addressed and staff actions taken to meet these needs. The registered manager must ensure risk assessments are completed consistently in regard to falls and the use of pressure mats. The registered manager is to undertake a review of medication. All medications indicated must be available and correspond with the records in place. Any gaps on the MARs are to be investigated to ensure residents are receiving their medication as prescribed. All medicines must be stored in compliance with their product WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 28 Timescale for action 30/04/07 2 OP7 15(1) 30/04/07 3 OP7 12(4)(a) 31/03/07 4 OP9 13(2) 31/03/07 licences to ensure their stability is maintained (this includes medications being stored at appropriate temperatures). This is outstanding from the November 2006 inspection. The original date for compliance was 30.12.06. 5 OP12 16(2) The registered manager is to further develop the activities programme for the home to ensure the social care needs of service users are met. The registered manager must make arrangements to ensure that all areas of the home are well maintained. This includes attention to paintwork, grouting around sinks and suitable bedding. 31/05/07 6 OP19 23(1)(d) 31/05/07 7 OP19 23(2)(m) The registered manager must 31/05/07 ensure there are suitable storage facilities available for the storage of toiletries in service user bedrooms. The registered manager must ensure that the home is maintained in a clean condition. This includes attention to carpets, cupboards, storage containers, equipment and general cleanliness. Infection control practices need to be reviewed to ensure there are suitable dedicated hand wash facilities for staff in the sluice/laundry areas. 30/04/07 8 OP26 23(1) 9 OP26 13(3) The registered manager must ensure that toiletries are not used communally with immediate effect. DS0000004265.V313725.R01.S.doc 31/05/07 WCS - Four Ways Version 5.2 Page 29 The registered manager is to review the provision of laundry equipment in the home to ensure this is suitable and sufficient to meet the laundry demands of the home. 10 OP27 17(2)Sch4 The registered manager must 31/05/07 ensure that duty rotas accurately reflect the staffing arrangements for the home including details of staff roles in the home to confirm there are sufficient staff available to support the needs of the service users. 9(1) The registered manager is to confirm completion of the Registered Managers Award to comply with the conditions of registration for the home. The registered provider shall ensure that a representative from the organisation visits on a monthly basis and prepares a written report on the conduct of the care home.(old timescale of 30.04.05 not met) This requirement is outstanding from previous inspections. The original date for compliance was 30.4.05, this was extended to 30.11.06. The additional extended timescale provided must be complied with. 13. OP38 16(g) 13(4) The registered manager must ensure temperature checks of food and fridges within the kitchenettes are carried out consistently. Food within fridges must be covered and stored as appropriate. WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 30 11 OP31 30/04/07 12 OP37 26, 17 Sch 4 30/04/07 31/03/07 Dried foods need to be stored in suitable sealed containers so they are pest proof and do not deteriorate. Eggs in kitchenettes need to contain a date or be kept within their original dated trays so staff know when to dispose of them. Food temperatures must be taken consistently to confirm this is safe for residents to eat. 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 OP38 Good Practice Recommendations Suitable actions should be taken to ensure cleaning schedules are completed to confirm cleaning of the kitchenettes consistently. Freezers in the main kitchen should be defrosted regularly to maintain effective food storage. WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI WCS - Four Ways DS0000004265.V313725.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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