Inspection on 30/11/07 for Weald Hall Residential Home

This inspection was carried out on 30th November 2007.

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

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

Other inspections for this house

Weald Hall Residential Home 08/09/08

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

CARE HOMES FOR OLDER PEOPLE Weald Hall Residential Home Weald Hall Lane Thornwood Epping Essex CM16 6ND Lead Inspector Gaynor Elvin Unannounced Inspection 30th November 2007 10:30 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 Weald Hall Residential Home DS0000070200.V356018.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. Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Weald Hall Residential Home Address Weald Hall Lane Thornwood Epping Essex CM16 6ND 01992 572427 01708 478151 michael502@btinternet.com 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) JK Healthcare Limited Mr Michael James Stevens Care Home 39 Category(ies) of Dementia - over 65 years of age (39) registration, with number of places Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection New Registration Brief Description of the Service: Weald Hall is a care home registered to provide accommodation and care to thirty-nine people over the age of 65 years who have dementia related care needs. The service is not registered to provide nursing care. The home is situated in a rural location on the outskirts of the small village of Thornwood Common, near Epping in Essex. It is a fairly isolated location and is not within walking distance from the village or main road; there is no public transport. The home is set in large well-maintained grounds, surrounded by farmland with views across fields and the private airfield, which runs alongside the grounds. The gardens and patio areas are suitable and accessible to those in wheelchairs or with other mobility problems, garden furniture is provided. The older style building, renovated and decorated to a high standard, provides accommodation on two floors. Personal accommodation consists of 39 rooms for single occupancy with en suite toilet and washbasin facilities. A passenger lift provides access to the upper floor. Some communal corridors are not wide enough for the larger wheelchair. The fees charged by the service range from £460.00 per week. There are additional charges for hairdressing, chiropody and newspapers. Weald Hall Residential Home DS0000070200.V356018.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 on 30th November 2007, over seven hours. It is the first inspection carried out by the Commission for Social Care Inspection since registration was approved in June 2007. All of the Key National Minimum Standards (NMS) for Older People and the intended outcomes were assessed in relation to this service during the inspection. This report has been written using accumulated evidence gathered prior to and during the inspection, which includes views expressed in comment cards completed by relatives, staff and healthcare professionals returned to the Commission; and information provided in the Annual Quality Assurance Assessment (AQAA), a self-assessment that focuses on how well outcomes are being met for people using the service completed by the home and returned to us prior to visiting the home. The inspection process included reviewing the progress of the service since its registration in June 2007, and looking at documents required under the Care Home Regulations. Additionally a number of records were looked at relating to the residents, staff recruitment, training, staff rosters and policies and procedures. Time was spent talking to Mr Parkash, the registered provider, Mr Stevens, the registered manager, staff and visiting relatives and healthcare professionals. Due to cognitive impairment and disorientation to time and place discussion with the majority of residents with regard to care delivery was difficult. What the service does well: Weald Hall provides a happy and relaxed atmosphere for the people living there. Interaction observed between the residents and the staff was comfortable, respectful and helpful. The staff team generally provide a good standard of care. The management team have a good recruitment system in place and all the required checks are made on new staff to ensure their suitability for the job. They also have a good training plan in place that ensures staff are suitably skilled. Feedback from relative comment cards indicate satisfaction with the service, One comment stated that the home ‘ is working to a very high standard’. Another stated ‘ they are making improvements all the time’. Another stated ‘ hard working staff, give friendly help and support. Food is good, surroundings are pleasant and visitors are made welcome’. Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 is not applicable to this service. Quality in this outcome area is good. The homes assessment process helps to ensure that only people whose needs can be met by the home are admitted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager described the homes pre admission process, through which an assessment was carried out to ensure the home was able to meet the individual’s needs. From the data provided in the Annual Quality Assurance Assessment (AQAA) we noted that the majority of residents were admitted directly from hospital necessitating a move to receive 24-hour care and support and introductory visits were not always possible. Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 9 The care records for the two most recently admitted residents were examined. Social service assessment information was available. In addition the manager undertakes a pre admission assessment and this was seen to cover presenting needs. The actual level of information completed in these documents varied and this impacted on how successfully a person centred plan could be developed to deliver quality care to meet the resident’s needs, abilities and preferences. This assessment could be developed further to ensure a more person centred approach to include dependency levels, strengths, abilities and specific dementia related needs. Weald Hall Residential Home DS0000070200.V356018.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): 7, 8, 9 and 10 Quality in this outcome area is adequate. People who use the service can expect to have their basic needs met with dignity and respect and their health care promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Whilst we were at the home, we observed and heard staff interacting well with residents. From observation and discussion with staff it was clear that they generally understood the individuals’ needs and provided a level of care that the residents appreciated. One relative commented ‘‘as far as I am aware the staff seem very caring of the elderly residents needs and privacy (i.e. when taking to the toilet) dignity is always maintained. The majority of residents always look clean and tidy, whenever I have visited’’. Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 11 Care plans tended to focus on immediate presenting needs and did not consider strengths and abilities and how staff can provide support consistently to maintain them. Aspects of these plans provided clear information for staff about the particular wishes and needs of the person to whom they related. There were other aspects where advice and guidance for staff were too general/brief and would not necessarily ensure a consistent approach in the most supportive manner and did not provide a clear basis upon which to review care practice. One care plan indicated that the individual ‘‘does not have difficulty in communicating but was confused at times’’, and required staff to ‘‘ensure that resident is able to express wishes and concerns’’. The absence of clear-recorded guidance for staff to follow does not enable staff to be sufficiently confident to deliver appropriate and agreed care. We noted that the care plan for a person admitted nearly two weeks previous was not completed and therefore did not demonstrate that this person was receiving appropriate, consistent and planned care and support to meet their assessed needs. Steps had been taken to obtain historical information about the individuals living in the home, this information needs to be utilised within the care plans to help staff to communicate with each individual and understand some of their anxieties that may link with past experiences. One relative commented that they would like to be involved in their relatives care review and maybe contribute in any way to help the persons stay more comfortable. This may be an issue to be considered when the team are reviewing their quality assurance systems. We noted that some records contained old plans that were generic and not individualised relating to poor eyesight and poor hearing even though these needs were not identified. The management advised us that the care plans were currently being reviewed and a person centred approach was being taken. The removal of old and irrelevant paperwork would avoid confusion to care staff. Care plans examined did not reflect emotional or specific dementia related needs. We noted that some residents had Lewy Bodies Dementia, a type of dementia with varying specific and complex related needs such as delirious episodes, hallucinations, sudden falls and Parkinsons symptoms. Although a fact sheet provided staff with general information about the condition, care plans did not identify the specific needs of each individual and provide guidance to staff on how these should be managed and supported. Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 12 Assessments of risk were seen for a range of issues. Clear management strategies to address any significant outcomes of the assessments were not incorporated within care planning arrangements. One assessment showed the potential risk to getting a pressure sore to be high and clear care planning arrangements were not included to inform staff of how to reduce, manage or monitor the risk identified. A healthcare professional with an interest in the service commented that ‘‘staff are generally pleasant and very approachable’’ and that healthcare needs are usually met by staff and individuals privacy and dignity is usually respected. Comments also indicated that staff knowledge and skills need to be developed in the physical aspects of care such as catheter care and pressure sore prevention, monitoring and management. We looked at records relating to healthcare of residents and found that referrals are made to healthcare professionals such as district nurses, opticians and chiropodist. One relative commented that staff acted promptly at their request, as they had concerns, to check their relatives’ blood sugar levels. This was found to be very high, the doctor was called and effective treatment was initiated. Comments from GPs stated that ‘‘staff care about the residents, are polite and chatty and seem to know each resident and their ways’’. They also indicated that they have found on occasions that staff were not fully aware of the residents physical and mental health conditions and have been unable to provide GPs with relevant information. The GPs also commented that continuity of care in a large home could be improved by structured and routine visits to the service for reviews of people’s chronic health conditions and medication reviews. Organised working in partnership with healthcare professionals should be developed further when the team are reviewing their quality assurance systems. We checked the medication management systems at the home. We found that these were in good order with clear records and returns system in place. Controlled medications were also stored and managed correctly. Weald Hall Residential Home DS0000070200.V356018.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): 12, 13, 14 and 15 Quality in this outcome area is good. The extent to which the activities meet the needs of the residents varies according to level of need. Relatives and friends of the residents are welcomed and the meal provision in the home is generally good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were some good elements of practice, which included staff’s cheerful and positive attitude. Continual short interactions and constant verbal exchange was observed between staff and residents. Staff gave gentle reminders throughout the day of what was happening next, to give residents some conception of time. The residents were observed to have varying cognitive and communication abilities, some experienced difficulties in word finding, decision making and choices, others had reasonable cognitive abilities but were troubled with little memory for events, conversation and people. Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 14 The sample of care plans examined showed that further work is required in order to demonstrate that residents’ individual and social care needs are being met. Some care needs assessments reflected individuals’ choices, past lifestyles, hobbies and preferred leisure activities. Better use of this information at the time of assessment and from family histories would enable staff to plan for identified social needs and inform staff in how to appropriately engage each resident in maintaining and stimulating social and recreational interests linked to individual dementia related needs. The home has recently employed an activity coordinator and management advised that this work is to be developed further. A member of staff commented ‘‘I feel that this service provides a happy home for people to live in. The residents appear to be a lot happier now an activity coordinator is in place. The service welcomes families when they visit and they are included in all social events’’. The management and staff team actively encourage and welcome family and friends to maintain relationships and visit the home. The home has an open door policy and relatives who commented said that they felt welcomed in the home and were invited to social events held within the home. One relative commented ‘‘I have found all the care staff very kind, obliging and professional. They have made taking my mum out for the day very easy. There are no time limits or restrictions. Staff welcome her back after a nice day out. Medication presents no problem’’. Social and entertainment events and activity are organised within the home such as a weekly music and exercise group and an outside entertainer visits the home once a month. A karaoke evening, a clothes party and a Halloween party was held in October, a slipper party in November, various entertainments and Christmas party arranged throughout Christmas period and a New Years party with live entertainment and a concert by Three Valleys male singers is arranged for January. Feedback from relatives comment cards were positive and included: ‘‘residents are encouraged to participate in activities, but also are able to have their ‘own space’ if they wish. There are three different lounge areas. My mother particularly enjoys the karaoke sessions and dancing. Also she likes to walk around the garden.’’ ‘‘staff always seem happy and encourage friends and relatives to join in activities, and even join in themselves!’’. ‘‘the residents are always encouraged to join in with the many activities going on in the day room. They seem to enjoy all the singing, dancing and quizzes’’. ‘‘staff will often spend time talking to …, if she is a little agitated or worried about something. They will spend time talking to the residents about the past etc.’’ Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 15 ‘‘A church minister attends regularly for those who wish to participate. Varied activities are available such as karaoke, dancing and pet therapy’’. The home has recently formed a resident committee to raise funds for the benefit of residents. A strawberry tea for friends and relatives held at the home raised £50.00. The committee also gains and considers ideas for the home and how money from fund should be used. One relative commented ‘‘we go to the residents meetings each month and things are being done to raise money for the benefit of the residents’’ The resident’s nutritional records demonstrate a varied diet. Food stocks looked satisfactory and catering staff were doing some home baking. Catering staff are able to order the food they require and said they have an ample budget. A selection of fresh vegetables is provided each day and fresh fruit is available. Tables were nicely laid. Staff wore appropriate protective apron and gloves to serve meals to the residents. The cook plated the food up from a serving trolley in the dining room. We observed all residents to receive the same. We observed that many residents experienced difficulty in hearing each other at the table and this limited social interaction; smaller groups seated at smaller tables would promote an inclusive and social atmosphere. The use of plastic cups should be reconsidered, as this does not promote peoples dignity. On the whole residents were assisted sensitively but we observed that some staff could benefit from some guidance in this area to ensure that all residents are given the assistance they require such as cutting up food. One relative commented ‘‘All residents are spoken to by name and I have shared lunch several times with my mother at the home and observed the care of the staff in presenting the food and trying to ensure that the residents eat, giving assistance as required. They are very patient and the food is good and varied’’. Weald Hall Residential Home DS0000070200.V356018.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): Quality in this outcome area is good. Complaint management in the home is generally good and policies and procedures are in place to help protect residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Relatives and health care professionals who commented stated that they had not had any concerns about the service. Relatives were aware of the complaints procedure and would in the first instance, contact the manager who is very approachable and would act upon any concerns promptly. Relatives also confirmed that they were kept informed of important issues and received information upon which to base decisions. One relative commented that ‘‘staff do their best to resolve any issues raised’’ There is further work to do in ensuring that those residents with cognitive impairments are able to make their views known, and is a point of development for a service that offers a specialist support to people with dementia. The home has a Safeguarding adult’s policy and the staff have been trained in recognising and reporting signs of abuse. The home carries out a robust recruitment procedure to ensure resident’s needs are met by staff that are appropriately suited to the job. Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 17 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): 19, 20, 21, 22, 23, 24 and 26 Quality in this outcome area is adequate. Resident’s benefit from an environment that generally meets their needs and provides a clean and comfortable place to live, however maintenance is not always carried out in a timely manner and may pose a risk to safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is large with long corridors. Recognition of the different corridors is difficult and only identified by the colour of the handrails. The décor in the home is pale. The use of colour and signage are recommended good practice in supporting independence in dementia. There are photos placed on doors to enable residents to recognise their room. The majority of residents’ bedrooms were personalised with their own belongings and were suitable to meet individual needs. Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 18 The home benefits from large gardens and seating areas that are well maintained for use by the residents in the good weather. The manager has an up to date infection control policy in place and staff have received training in this area. Equipment was provided to promote mobility and maximise independence and a variety of pressure relieving aids were observed on beds and chairs. Storage space was limited and recent deliveries and stock of continence pads and gloves posed a trip hazard in the bathroom. Packets of clean continence pads, some open were inappropriately stored ion the floor of the sluice room a dirty area posing a risk to cross infection. During the tour of the building we noted a serious issue in relation to extreme hot water temperatures from some bathroom and sink hot water taps. We also noted that the water outlet was blocked in the bath of one of the bathrooms on the first floor. The water was dirty and stagnant, and the bath stained indicating that it had been like this for some time. The toilet was also leaking and the floor wet. The room in this state posed a safety hazard and reduced bathing and toilet facilities. The bathroom was not locked and did not have a notice on the door to prevent residents from using it. The responsible person was not aware of this issue until we brought it to his attention and he assured us it would receive immediate attention. The boiler room was not locked and accessible to residents. One relative commented that there was ‘‘an apparent lack of a caretaker or handyman as failed light bulbs have not been changed promptly, no light in the passenger lift meant a torch had to be used, minor jobs such as pictures not put up in bedrooms despite repeated requests, loose door hinge and toilet seat not attended to’’. The new provider has assured us that these issues were prior to them taking over the home and have since been addressed. Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 19 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): 27, 28, 29 and 30. Quality in this outcome area is good. Residents can expect to be protected by the homes recruitment practices and are supported by staff that have successfully achieved the recommended qualification in care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Initially when the new providers took over the home staff turnover necessitated the use of agency staff, the management confirmed that the home has since settled and a full staff team has now been established. There are three senior members of staff in post to support the manager in the day-to-day management of the home. In addition to the manager and a senior in charge the home is staffed by 6 care staff during the morning, afternoon and evening. At night one senior and two carers staff the home. The home also employs dedicated cleaning, laundry and kitchen staff as well as an activity coordinator. There was no assessment evident to demonstrate that staffing levels were calculated or reviewed according to resident’s current and changing needs. Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 20 Observations made during the inspection suggest that additional staffing may be required particularly with regard to the size and layout of the home and the residents varying cognitive abilities. Some requiring a significant amount of dedicated one to one time for any interaction to have a meaningful input into the quality of their lives. We reviewed the recruitment procedures at the home and found that all required staff checks and documentation was in place to assist the home in protecting residents from unsuitable applicants. The manager has started using the Skills for Care induction programme for new staff and records were available to show that these were being used. There has been an increase in staff training opportunities, and information provided in the AQAA indicated that the service has successfully exceeded the recommended target of 50 of care staff workforce with a National Vocational Qualification (NVQ) level 2 in Care. The home has a training programme in place and uses the services of the company trainer to move the programme forward. Records show a reasonable level of compliance with statutory training and that appropriate additional training is offered and taken up by staff. There are gaps remaining in areas such as health and safety, fire safety and first aid. The majority of staff have undertaken introductory short course attendance training at a basic level in understanding and caring for people with dementia. It would be good to see this training reflected in the care planning for residents. The development of individual training and development profiles that use information gathered from supervision and residents needs assessments would further enhance the skills base of the service. Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 21 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): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. The management of the home is good and work is being done to develop the staff team and the home in the best interests of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has re located his office to the main entrance of the home and this enables him to be visible and accessible to all visitors to and from the home. Discussions with staff indicated that they felt they received appropriate guidance and support from the management team. Staff and residents spoken with felt the Manager was approachable and supportive. Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 22 One member of staff commented ‘‘I would just like to say that never before have I been so happy working somewhere. I find Weald Hall a very happy place to work. It’s a very rewarding job’’. Three senior members of staff support the manager by leading the shifts and care delivery, and this arrangement not only makes better use of the time available to the manager, but also provides opportunity for the manager to concentrate on skills and development of the staff team. Regular staff meetings and meetings with relatives have ensured good communication and progression of current changes under new ownership. The introduction of a newsletter provides another form of communication that includes information about the home, social events and personal news relating to staff and residents such as birthdays. In the home’s first six months since registration the management team have obtained feedback from relatives and other stakeholders to inform changes for improvement in the running of the home. One member of staff commented ‘‘since the home has been taken over by the new provider, everything he has said he will do – he has done. The service is a lot better and improving all the time’’. The management of the hot water system in the home is an issue requiring attention. Temperatures were noted to be very hot and control is difficult posing a health and safety risk for residents. We were advised that despite having thermostatic valve controls the temperatures of hot water outlets were checked on a weekly basis and the temperature control valves adjusted accordingly. This was also reflected in the responsible persons monthly monitoring visit report. In view of the high temperature found in some but not all of the hot water outlets it is recommended that the thermostatic control is checked by an appropriately qualified person and appropriate risk assessments and risk management strategies, monitoring and recording put into place. Residents, particularly those who are elderly and have dementia, are potentially at risk of scalding if in direct contact from hot water outlets and when using hot water from hand washbasins in their rooms. The management are in the process of introducing a range of internal audits. Health and safety risk assessments and audits are essential to ensure that issues in the home are attended to, for example maintenance and repair and hot water temperatures. Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 23 As a service with a specialist category of care for people with dementia the homes quality review systems need to be extended by developing quality monitoring and assessment specific to dementia care outcomes. A method to provide an open and analytical review of the care and support currently provided should be used to identify any actions required that would impact on improving outcomes for residents; and consideration given as to how the residents with cognitive impairments are able to contribute to the quality assurance. Ways of obtaining the views and experiences of the residents needs to be explored to ensure the home is run in their best interests and the quality of life for people with dementia is promoted. The development of a policy may help the management to focus on what they need to do over the course of a year. The Annual Quality Assurance Assessment (AQAA) requested by the Commission informs the inspection process. All sections were completed and the information provided gave us a reasonable picture of the current situation in the home. There were areas where more information would have been useful to illustrate how the service identified areas for further improvement and the ways that they were planning to achieve this. Monitoring visits by Mr Parkash, the Responsible Person, on the conduct of the home are carried out monthly and reports on the findings are sent to the Commission and kept for inspection purposes. Records relating to health and safety of equipment and systems operating in the home were examined including fire safety equipment, annual maintenance of lift, moving and handling equipment and electrical installation safety and were in date. The management advised us that following an inspection by Essex Fire Safety Department the home satisfactory met its statutory fire safety obligations. Fire safety risk assessments and an evacuation plan were evident. In view of the size and age of the building the evacuation plan should be developed further to ensure the evacuation needs of individuals have been addressed and recorded in their individual care plans; and appropriately communicated and that staff are aware of the evacuation needs of the resident group and individuals. The fire escape on the first floor was locked and the key was stored loosely in the fire extinguisher cupboard. The key must be kept in a secure and visible place such as a glass box attached to the wall and this must be addressed. The sample of training records inspected indicated that staff had recently received training in food hygiene, infection control and moving and handling. The AQAA informed us that 21 staff in total had received training in infection control. Gaps were identified in statutory training areas such as Health and Safety, Fire Safety and First Aid. Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 24 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 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 3 2 3 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 23 13 Requirement Timescale for action 01/03/08 2. OP33 24 A system must be developed to ensure the premises are regularly checked in relation to maintenance and health and safety. Adequate and suitable storage space must be provided for the purposes of the care home to reduce hazards to residents. The homes quality assurance 01/07/08 must be developed to include a system specific to reviewing, evaluating and improving the quality of care provided and outcomes for people who live there, with a focus on the quality of life experienced in the home by people who have dementia to ensure the home is run in their best interests. Individual risk assessments 01/03/08 should form part of the residents care plan and be carried out to identify potential scalding risks from hot water temperatures and to assess vulnerability of those who have access to bathing and washing facilities. DS0000070200.V356018.R01.S.doc Version 5.2 3. OP38 13 Weald Hall Residential Home Page 26 Safe working practice risk assessments should be reviewed to ensure they are up to date and staff are well informed of identified risks and how to reduce them. 4. OP38 23 The key to the fire escape route 01/03/08 must be kept in a secure and visible place to enable it to be safely located in an emergency. 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. 2. 3. Refer to Standard OP7 OP8 OP12 Good Practice Recommendations Consideration should be given to developing a more person centred approach to the care planning system, especially in relation to the care of people with dementia. Risk assessments, completed for residents, should link into the care planning process, so that management of the identified risk is clear. The activity programme needs to develop in order to consider how it can best provide meaningful interaction according to individualised social needs for all of the people who live there. Table settings at mealtimes should be reviewed in order to promote a congenial setting that promotes social inclusion. The development of individual training and development profiles that use information gathered from supervision and residents needs assessments would further enhance the skills base of the service. 4. 5. OP15 OP30 Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Weald Hall Residential Home DS0000070200.V356018.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!