CARE HOMES FOR OLDER PEOPLE
WCS - Four Ways Mason Avenue Lillington Leamington Spa Warwickshire CV32 7PE Lead Inspector
Kevin Ward Unannounced Inspection 8th March 2006 07:50 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.V285694.R01.S.doc Version 5.1 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.V285694.R01.S.doc Version 5.1 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.fq.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.V285694.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The Registered Manager must undertake the Registered Managers Award by 30th April 2007 10th August 2005 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. Accommodation is over three floors, there is a lounge/dining area upon each floor. 18 bedrooms have en suite facilities. In addition, Four Ways caters for up to eight-day care users from Tuesday to Friday inclusive. 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. WCS - Four Ways DS0000004265.V285694.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection and was time limited. The inspection focused on reviewing the home’s progress to meet the requirements of the last inspection and on assessing a number of key standards. The inspection involved talking with the manager, staff and service users at the home and examining a number of records, including care plans, training matrix, staff files and some policies. What the service does well:
Service users needs are properly assessed before moving in and they are given the opportunity to visit and see the home before moving in. The home also allows people to bring items of furniture and personal belongings with them to help them to personalise their bedrooms and to feel at home. Lengthy care plans were seen containing the essential information that is required to help staff to meet people’s needs. Good arrangements are in place for reviewing service users care plans on a monthly basis. Review meetings are also taking place shortly after people have moved into the home to ensure they are settling in well. Similarly annual reviews are being carried out involving service users, relatives and social workers, in addition to review meetings, to consider specific concerns that may crop up during the year. Entries in service users’ review notes confirm that the home encourages people’s relatives to support them in review meetings. 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. An activities plan was seen outside the lounges in the home to inform service users about the times of planned activities. Examples of activities recently provided include, pub meals, ASDA trip, line dancing, reminiscence therapy, dominoes, sing-a-long and quiz nights. Most service users indicated that they are generally happy with the level and type of activities at the home. The manager explained that she has plans to survey the views of service users shortly, with a view to reviewing the activities provided at the home. Suitable procedures are in place for service users and their relatives to complain. A complaints log was seen containing evidence to demonstrate that complaints are taken seriously by the home and are appropriately followed up and investigated. The home was found to be clean, comfortable, and free from any unpleasant odours. WCS - Four Ways DS0000004265.V285694.R01.S.doc Version 5.1 Page 6 The recruitment files of two recent starters were examined and found to contain suitable evidence to verify that new staff are properly vetted to ensure that they are suitable to work at the home. The manager stated that all the current service users have support to manage their finances from their relatives or advocates. Suitable arrangements are in place for recording service users daily expenditure to account for their cash balances that are held in safekeeping by the home, including an annual audit by a person who does not work in the home. What has improved since the last inspection? What they could do better:
Overall service users care plans contain helpful advice and information to enable staff to provide good care. However the personal history section still needs to be completed in most cases, so that staff have a good idea of people’s life experiences and personal interests. The manager explained that she has plans to review the level and type of activities provided at the home in order that amendments may be made to the activities programme where necessary. Overall the home has suitable arrangements in place for maintaining the home in safe condition for service users to live in, however there is a need to provide evidence on site to confirm that gas appliances are maintained by a Corgi registered person. WCS - Four Ways DS0000004265.V285694.R01.S.doc Version 5.1 Page 7 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. WCS - Four Ways DS0000004265.V285694.R01.S.doc Version 5.1 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.V285694.R01.S.doc Version 5.1 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): 3 Service users’ needs are assessed by the home before they move in so that it is clear their requirements can be met. EVIDENCE: Information contained in service users files provides evidence that the home has a proper assessment process in place for new service users referred to the home. This includes requiring assessment information and care plans from placing social workers. The home also carries out it’s own assessment of service users’ needs to ensure that the home is able to meet their needs and to develops a comprehensive care plan for people. Good systems were seen to be in place for assessing the dependency levels of service users in order that the home supports a correct balance of higher and lower dependency people so that everyone’s needs can be met effectively by the home. WCS - Four Ways DS0000004265.V285694.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9 Care plans are regularly reviewed with the involvement of relevant people, on a regular basis, so that people’s needs are monitored and met EVIDENCE: A sample inspection of care plans was carried out. Overall the care plans were seen to cover a wide range of needs and provide suitable levels of information to aid staff to give good personal and healthcare support to service users. Some care plans contain good levels of personal history information that provides a very helpful personal profile about service users’ lives and interests. This information still has to be developed further for some people. 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. Care plans are also being checked by the home and where necessary amended, each month. It was noted that new amendments to care plans are now being dated, in keeping with the requirements of the last inspection. Service users’ dependency levels are recorded on an ongoing basis to provide a clear picture of changes that have taken place in individuals needs during their
WCS - Four Ways DS0000004265.V285694.R01.S.doc Version 5.1 Page 11 stay at the home. This information is used by the manager to identify and responds in trends in care across the home. A medication procedure is in place at the home. Training information provided by the manager indicates that the majority of staff have been provided with medication training since the last inspection. This was verified in discussions with staff at the home. Lockable storage arrangements for the safe keeping of medication are in place, on each of the three floors of the home. A controlled drugs cabinet is also in place at the home and a register is used to appropriately account for these medications. The reasons that people are given “as required” medications is now recorded on their medication sheets and more detailed information regarding the reasons that medication is prescribed is recorded in service users’ care plans. The manager agreed to develop protocols for people using medication, on an “as required basis”, to put in the medication file, to include greater advice to staff, regarding when this medication should be given and under what conditions, e.g. the earliest time sleeping tablets may be given. The manager explained that it’s the policy of the home not to give any none-prescribed home remedies to service users. WCS - Four Ways DS0000004265.V285694.R01.S.doc Version 5.1 Page 12 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 and 13 Service users are being consulted about activities and personal interests and are encouraged to receive visits from relatives and friends in order that their social needs may be met. EVIDENCE: A timetable of planned activities was seen near the lounge areas to remind service users of the dates and times of specific events. Comments made by service users indicate that they are made aware of this information and are able to choose which activities they wish to take part in, subject to the number of spaces available on the day. Comments made by service users spoken to during the inspection indicated that in most cases people are generally satisfied with the level of activities taking place at the home, although a small number of people indicated that they would like more activities. Last month the manager used questionnaires to seek people’s views about the food in the home and explained that she was planning to consult service users over levels and types of activities, with a view to increasing the options available to people. Examples of activities that take place at the home include, pub meals, supermarket, line dancing, reminiscence therapy, sing-a-long, quiz nights and film nights. Service users’ relatives are encouraged to visit throughout the day or evening and there no unnecessary restrictions imposed on their visits. The manager
WCS - Four Ways DS0000004265.V285694.R01.S.doc Version 5.1 Page 13 explained that visiting is flexible, although visitors are asked to inform the home if they intend to visit after 10pm at night, for security reasons. Evidence of relative’s visits and attendance at care reviews was seen, in entries, in service users’ records. WCS - Four Ways DS0000004265.V285694.R01.S.doc Version 5.1 Page 14 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 and 18 Suitable procedures are in place for managing complaints and recognising and responding to suspicions of abuse so that people’s concerns are taken seriously and service users are protected. EVIDENCE: A complaints procedure was seen to be in place for staff at the home and a summary of the procedure is on the wall in the corridor for the benefit service users and visitors. Comments and complaints books are also in the hallways on each floor for people to register positive comments about the home and to bring any concerns to the attention of the manager. A complaints log is also in place for recording and tracking complaints made at the home. An examination of the log provides evidence to confirm that complaints are followed up properly and that the findings of investigations are recorded. A policy and procedure for the protection of vulnerable adults is available at the home and a copy of Warwickshire Social Services policy on these matters was seen in the office. There has been one recent adult protection issue that the manager has appropriately brought to the attention of Social Services, the Commission for Social Care Inspection and relatives and that actions were taken to reduce any subsequent risks to service users. Training information provided by the manager indicates that over 50 of staff have previously received training in the prevention of abuse and that 12 more staff are planned to go on this training in June this year. WCS - Four Ways DS0000004265.V285694.R01.S.doc Version 5.1 Page 15 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): 26 Suitable arrangements are in place for maintaining hygienic conditions so that service users live in a clean home. EVIDENCE: A hygiene and infection control policy was seen to be available to staff in the home’s policies folder. Protective clothing for carrying out domestic tasks were seen to be available in the home and different aprons for serving food were seen, to support good hygiene and infection control practices in the home. This is in keeping with a requirement made at the last inspection. The laundry room is situated well away from the kitchen and dining room areas of the home so there is no risk of contamination, due to laundry being carried through food preparation areas. Suitable procedures are in place for managing continence laundry in the home. The home was seen to be clean and tidy and free from any unpleasant odours. WCS - Four Ways DS0000004265.V285694.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 Suitable recruitment and vetting procedures are in place at the home so that service users are protected by the home’s recruitment procedures. EVIDENCE: The recruitment files of two recently employed staff members were examined. The files were seen to contain evidence to confirm that staff are interviewed and that vetting checks are taken up before staff start work, including evidence of identity, two references and POVA first / Criminal Record Bureau Checks. Comments made by staff confirmed that they receive regular supervision and that the manager and deputy manager at the home are always accessible to support them to carry out their roles effectively. WCS - Four Ways DS0000004265.V285694.R01.S.doc Version 5.1 Page 17 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): 35 and 38 Suitable arrangements are in place for managing people’s cash so that their money is properly accounted for. With the exception of gas maintenance records, overall, suitable arrangements are in place for maintaining health and safety equipment in the home, in order that the home is a safe place for service users and staff. EVIDENCE: The manager explained that the home is not currently holding and personal bank books for any of the current service users. Support to manage service users’ finances is sought from relatives or advocates. Two people are currently being supported by staff of Warwickshire Advocacy Alliance. Cash for day-today expenditure is held securely at the home and suitable arrangements are made for accounting for these monies. Access to service users’ money is restricted to the management team within the home. Two staff sign for all
WCS - Four Ways DS0000004265.V285694.R01.S.doc Version 5.1 Page 18 withdrawals and the manager carries out regular audits of expenditure records. The manager also confirmed that service users’ expenditure records are audited by the organisation. The signature of the auditing officer was seen on service users’ records as verification of this fact. An examination of the home’s fire safety log provided evidence to confirm that fire alarms and lights are being routinely tested and that fire safety equipment is being properly serviced and maintained in safe working order. Maintenance records were seen to confirm that electrical equipment has been tested in the last two years and is due again shortly that the home’s hard wiring has also been checked. Similarly suitable arrangements are in place for maintaining lifting equipment and for the collection of clinical waste. Gas maintenance records were seen at the home, indicating that gas equipment is being routinely maintained however there was no documentary evidence, e.g. landlord gas safety certificate or letter head, to demonstrate that the contractors carrying out the maintenance are Corgi qualified. WCS - Four Ways DS0000004265.V285694.R01.S.doc Version 5.1 Page 19 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 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 x x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x 3 x x 2 WCS - Four Ways DS0000004265.V285694.R01.S.doc Version 5.1 Page 20 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 OP37 Regulation 26, 17 Sch 4 Requirement 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) Arrange for a landlord gas safety certyificate to be held at the home or other evidence to demonstarte that the contrcator carying out gas maintenance is CORGI registered. Timescale for action 14/04/06 2 OP38 23 (2) (c) 14/04/06 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 7 Good Practice Recommendations Complete personal history information in service users assessments where this is still necessary. WCS - Four Ways DS0000004265.V285694.R01.S.doc Version 5.1 Page 21 2 9 3 12 Proceed with plans to devise written protocols for medication that is prescribed for service users to use on an “as required basis” so that staff are clear regarding when this medication is to be given, e.g. earliest time of night at which sleeping tablets may be given. Proceed with plans to survey the views of service users regarding the type and frequency of activities at the home. WCS - Four Ways DS0000004265.V285694.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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