Inspection on 08/11/07 for Wear Court

This inspection was carried out on 8th November 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

Wear Court 27/05/10

Wear Court 17/05/10

Wear Court 16/03/10

Wear Court 18/02/10

Wear Court 11/12/09

Wear Court 30/07/09

Wear Court 01/08/08

Wear Court 01/12/06

Wear Court 25/01/06

Wear Court 13/09/05

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Wear Court Rock Lodge Road Roker Sunderland SR6 9NX Lead Inspector Irene Bowater Key Unannounced Inspection 8th November 2007 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wear Court DS0000064820.V354353.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. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wear Court Address Rock Lodge Road Roker Sunderland SR6 9NX 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) 0191 5496441 0191 5485305 Moorlands Care Homes (N.E.) Limited Position Vacant Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 4th July 2007 Brief Description of the Service: Wear Court Nursing Home provides nursing and personal care for 30 older people. The home is situated in a residential area of Sunderland approximately 50 metres from the sea front and within easy reach of public transport facilities. The three-storey house was originally a residential dwelling and was converted to a care home in 1993. There is a passenger lift, which provides access to most areas of the home. A stair lift provides access to several bedrooms on the first floor that are inaccessible via the passenger lift. There are twenty-seven bedrooms, four of which are double and are currently used as single rooms. Eight single and two double rooms have en-suite toilet facilities however, some are not of a suitable size to allow access for wheelchair users or people with mobility difficulties. Corridors and door widths are wide enough to allow access for wheelchair users. The laundry, kitchen, dining room and lounge areas are all on the ground floor with the majority of bedrooms on the upper floors. There is a conservatory to the rear of the building, which overlooks the private and mature gardens. Fee rates vary. Low band nursing £399 per week, Medium band nursing £442 per week; high band nursing £492 per week. There are extra charges for hairdressing, chiropody, optician and dental care. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the visit: We looked at: • Information we have received since the last visit on 4 July 2007 • How the service dealt with any complaints and concerns since the last visit • Any changes to how the home is run • The provider’s view of how well they care for people • The views of people who use the service and their relatives, staff and other professionals. The Visit: An unannounced visit was made on 8 November 2007 During the visit we: • Talked with people who use the service, relatives, staff, the nurse in charge and visitors • Looked at information about the people who use the service and how well their needs are met • Looked at other records which must be kept • Checked that staff had the knowledge, skills and training to meet the needs of the people they care for • Looked around the building to make sure it was clean, safe and comfortable • Checked what improvements had been made since the last visit • We told the nurse in charge what we found. What the service does well: Staff gather information about the person before they move into the home to make sure they can meet their needs. Staff talk with other professionals to ensure residents health care needs are met. Good relationships have developed between staff and residents Care was given discreetly and with sensitivity. Medication procedures are followed which promotes residents health. Meals are nicely cooked and of ample portion size. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 6 Staff have received the training they need to care for the residents. Visitors are welcomed at any time. Residents said: “They are good staff” “Everything suits me” “The food is fine” Comments received from the surveys sent out by the Commission included: “I am sure the qualified staff have the correct skills and I think the carers do (most of them)”. “If I had a complaint, make first approach to manger or matron”. “Wear Court has a friendly homely atmosphere. Visitors are always made welcome” “All residents are loved, cared for and well fed at Wear Court.” “The staff all care and attend every need X has” “I feel the care is excellent and X is very happy living there”. “We do not have any concerns at all. The staff are more like friends and this is a good factor for us and X” “The staff appear to have a good rapport with the clients”. “They always appear well dressed, clean and comfortable.” What has improved since the last inspection? Care plans now show how the care is being provided. They were clear and up to date regarding peoples health and personal care needs. A part time administrator has been employed to deal with some of the office work in the home. Following two additional visits to the home and issuing of requirements some immediate improvements were made to the home. Other improvements have included: Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 7 A “wet room” and a shower room have been installed and are now in working order. Lounge carpets and part of a corridor carpet has been replaced. Limited redecoration and replacement of bedroom furniture has started. New washing machines have been provided. Lighting in some areas has improved. What they could do better: Some attempts have been made to improve the Statement of Purpose and Service User Guide. The registered persons need to produce information about the home in a style suitable for potential and current residents and make it readily available to them. Information about residents’ previous lifestyles and choices need to be written down so that staff can continue to support them. The activities need to be developed and information taken from relatives to ensure that residents’ social care needs can be met The menu choices and alternatives for all meals need to be written down so that staff can be sure all residents’ nutritional needs are met. The complaints procedure needs to be easily understood and readily available. All concerns and complaints need to be recorded with clear information of the investigation, action taken and outcomes recorded within 28-day timescale. “I don’t know how to make a complaint but no doubt I could find out.” Further safeguarding training will make sure that all staff have a clear understanding of what constitutes abuse. Areas of the home that need repair, redecoration and refurbishment must be dealt with according to priority need and within timescales given. Infection control polices and procedures need to be put in place to make sure the possibility of any outbreak is minimised. Robust recruitment procedures need to be followed to make sure residents are protected at all times. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 8 The staffing levels need to be monitored to make sure all of the residents needs are met. The staffing levels include ancillary staff. The Commission must be informed in writing should levels be reduced. A suitable manager of the home needs to be recruited Quality assurance and quality monitoring systems need to be introduced, to promote and improve the quality of the service offered to residents. All records need to be brought up to date, be in good order and kept securely. Repairs and cleanliness in the kitchen needs to improve. All health and safety issues must be dealt with, records kept and completed within agreed timescales. All of the requirements identified in the report must be actioned within the timescales given. 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. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 9 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 Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 10 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): 1,2,3. Standard 6 is not applicable to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence gathered both during and before the visit to this service. While people’s needs are comprehensively assessed before moving in, information about the service lacks enough detail to help people make an informed choice. EVIDENCE: The statement of purpose and service user guide still does not clearly set out the aims, objectives, philosophy of care, services and facilities and terms and conditions of residency. This prevents people from having all the information they need about the service to help them make a fully informed choice before deciding to use the service. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 11 Some amendments were made but they still need to be reviewed to show the changes that have been made. Old information is still available making reading difficult to follow. The service user guide is still not clear and some residents don’t have a copy. Residents do have a preadmission assessment, which is carried out by qualified nurses. For example when the qualified nurse went to the hospital to carry out an assessment it was decided that the home could no longer meet this persons needs. Also available are the initial care plans written by care managers and nurse assessors. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 12 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): 7,8,9,10. Quality in this outcome area is good. This judgement has been made using available evidence gathered both during and before the visit to this service. Healthcare needs are well promoted and delivered in a sensitive way that ensures people’s rights to privacy and dignity are protected. EVIDENCE: Each resident has a plan outlining how their care needs will be met which include information about religion and beliefs but don’t explore other aspects of diversity in any detail. Care plans are based on preadmission assessments carried out by care managers, the home manager and when necessary the nurse assessor. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 13 The assessment tools include pressure sore risk, dependency, moving and handling, nutritional assessments using the Malnutrition Universal Screening Tool (MUST), continence and fall risk assessment. Case tracking showed that the qualified nurses have worked hard to bring the care plans up to date. Two examples’ shows how the staff have involved other professionals in reducing a persons falls and another shows how working with the tissue viability nurse has improved a persons pressure sore. One person who was very poorly on admission has had an improvement in their health care. This person has started to communicate, their weight has increased and wound care has vastly improved Risk assessments and evaluations of care are now carried out at least monthly. There is also evidence that the health care of residents is improving. Those who are at risk of pressure damage have risk assessments in place and care plans show how staff are carrying out wound care. Although social profiles are being completed the care plans still focus on the nursing needs of residents by looking at clinical tasks rather than the whole person. Staff are trying to develop a person centred approach to care delivery. Weights are monitored at least monthly and advice is sought from tissue viability specialists, fall prevention nurses, speech and language specialists and psychologists. The residents have access to all NHS facilities to ensure their healthcare needs can be met. There are regular visits from GP’s and other health professionals including, dentists, opticians and chiropody services. The home has medication policies and procedures for staff to follow. The room used for the storage of medication is very small. There is no bench space for staff to work at and due to the limited space was quite cluttered. The staff do not keep a separate book when ordering medication. This information is recorded on the Medicine Administration Record (M.A.R.) Good records of all medication are kept. Staff have sight and keep a copy of all prescriptions and this ensures there are no errors in the drugs ordered for people. An audit of Controlled Drugs and the Medicine Administration Records (M.A.R.) showed no discrepancies. There was suitable storage of medicines and no excess stock. And a pharmacy inspection was carried out by Norchem Healthcare Ltd 0n the 24.September 2007 and the issues identified have been addressed. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 14 The relationships between staff, residents and relatives, were friendly and professional. Care was delivered in private and staff were seen to knock on doors and wait for permission before entering. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 15 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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence gathered both during and before the visit to this service. Although residents are actively encouraged to make decisions, daily life is restricted by limited opportunities to lead a fulfilling life. EVIDENCE: There is an activities person who is employed for twenty hours a week. This person is on annual leave for three weeks. Information about activities and events is not displayed to tell people what is being planned in the home but a diary is kept which shows if people have taken part in any activities. In the garden there were remnants of a ‘Bonfire Night’ event that had been held and residents said they had enjoyed ‘the children and staff coming in’ to see the fireworks. The ‘Pat dog’ person also called at the home and calls in once a week but records don’t show in any detail the events that took place. Information is recorded in a tick list style. This doesn’t help staff plan future events with people and doesn’t give any insight into whether events were appreciated or enjoyed by people. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 16 Staff are just starting to develop social care plans. Residents are not fully involved or consulted about choices of daily activities both inside and out of the home. The residents confirmed that family and friends are always made welcome and can visit at any time. Information about advocacy is available. Many of the residents have brought small items with them making their rooms homely and reflective of their previous lifestyles, religious beliefs or cultural backgrounds. The home has one large dining room, which has been redecorated. This has improved the room, however there are not sufficient dining room chairs which are suitable for the residents to use. This means that most of the residents have to remain in their wheelchairs through out the meal. The dining tables are set in rows, which makes conversation difficult. The provision of large round tables would enable residents to better interact with each other during mealtimes, and ‘glider’ type chairs would be more comfortable and safer for residents to use. The dining tables were appropriately set with tablecloths, cutlery, crockery and individual condiments. There is a four-week rolling menu. These do not set out choices or alternatives for all meals. For example, “seasonal vegetables” and “soup and sandwiches”. Records of food provided and alternatives offered are not available. Staff were able to say what they would offer and provide if someone was not well or was losing weight but this is not recorded. This means that the staff cannot be sure that all residents have a varied and balanced diet. The staff were kind and attentive to all of the residents and the lunchtime meal was a pleasant period. Residents said: “The food is fine” “I get enough to eat” Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 17 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): 16,18 Quality in this outcome area is poor. This judgement has been made using available evidence gathered both during and before the visit to this service. Adequate complaints and safeguarding systems are in place but staff lack the skills to deal effectively with concerns about the service and residents are not fully informed about how to make a complaint. This means that complaints/safeguarding issues may not be listened to or acted upon appropriately and may put people at risk of harm. EVIDENCE: The home does have a complaints policy and procedures have recently been revised following a recent complaint that was not dealt well dealt with by the service. This resulted in the issue being dealt with via Sunderland Council’s safeguarding procedures and their Service Improvement Facilitators becoming involved with the service and conducting visits. The owner took steps to implement a voluntary suspension of placements until he had met their recommendations. Information about how to complain is pinned on a sheet of paper behind bedroom doors and is now included within the home’s Statement of Purpose. But this is not written in an easy to read style. For example, the first sentence states: “It is acknowledged that people find it difficult to complain in view of fear of reprisals of some sort”. This information is difficult to access and read. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 18 No records of complaints made could be found even those that the Commission (CSCI) have knowledge of. Staff have completed safeguarding training that links into the Local Authority Procedural Framework. Although training has taken place understanding of what constitutes abuse is sometimes not fully understood by all grades of staff. And everyday practices are not always recognised as potential safeguarding issues. For example, one person spends all their time in their bedroom because of their state of health and together with the location of their bedroom this further isolates them from other people. There are periods during the day when they are left alone with no music or TV or company. A room nearer to the ‘hub’ of what is happening in the home, where staff could ‘pop in’ and see they are comfortable and check on their needs would prevent this. Since February 2007 there have been two safeguarding alerts. One has now been closed and the Local Authority is still investigating one. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 19 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): 19,20,21,24,25,26. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to the service. The lack of maintenance and renewal of equipment and facilities mean that residents are potentially at risk from equipment that may be unsafe. The poor condition of the décor and fixtures and fittings means that residents’ live in an inadequate environment. There are infection control and safety issues, which potentially place residents at risk of harm. EVIDENCE: There has been little change to the environment despite two random visits to the home and a meeting with the provider of the service. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 20 New carpets have been laid in the lounges and part of a corridor. The downstairs bathroom has been refurbished and turned into a “wet room” and one bathroom upstairs has had a shower fitted. The conservatory is sparsely furnished. Ivy is growing through the conservatory wall. The curtains were pulled back from the side windows in the lounges. Ivy and old bird droppings thickly covered the outsides. Another small window has a hairline crack. Windows in the lounges and some of the bedrooms are difficult to open as they have either been painted shut or the catches are broken. There is damage to all of the paintwork through out the home due to wear and tear and use of wheelchairs and trolley’s. Lighting in the home needs to be checked to make sure it is domestic in style and bright enough for reading and other activities. The lighting on the third floor next to the lift was not working making this area very dark. Staff were not sure if thermostatic mixing valves were fitted to prevent risks of scalding. Water in unused bathrooms is not run on a regular basis. Other areas of concern are: • Lounge chairs are old, ripped and stained •Window opening have been painted over •Wallpaper is stained, marked and ripped •Redecoration is needed to the ceilings •Carpets are old and stained •Handrails are stripped of paint •There are not sufficient or suitable dining chairs for residents •Paintwork throughout the home is chipped and wheelchair damaged. •Flooring in all of the bathing and toilet facilities is worn and damaged •Taps are encrusted with lime scale. •Toilet brushes are left in soiled containers •Soiled incontinence pads are not always put in clinical waste bags. Limited redecoration and refurbishment has taken place to bedrooms. Furniture in the bedrooms is old and damaged through wear and tear. Some of these are beginning to fall apart. The armchairs are stained and old and carpets worn down to the thread. One wall in an en suite is damp and the wallpaper is falling off. There was an odour problem in some rooms. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 21 One room had no light shade and the call bell was tied out of reach. Doors to the sluices are left open and the sluice disinfector is broken. There was a “flood” in one sluice and the flooring has been taken up. Carpet has been laid which is a potential hazard and infection risk. The sluices had an odour problem but a letter from the owner states that a replacement ‘sluice master’ is on order. The open hoppers were dirty and smelly. Bins do not have lids nor are they foot operated, all of which are poor control of infection processes. The use of bar soap was evident in several areas and liquid soap and paper towels were not available in all resident areas to allow effective hand washing. The laundry remains small and cluttered. Two new washing machines with a sluice programme have been provided in the summer and some improvements to storage and safety were made following immediate requirement notices served during the random inspection on the 4th July 2007. However, there is still damage to the flooring and the walls have plaster missing and are not easy to clean. The sink was filthy and had obviously not been cleaned for some time. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 22 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): 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence gathered both during and before the visit to this service. Sufficient numbers of competent and adequately trained staff are employed to meet people’s needs but appropriate vetting of staff is inconsistent. This may leave people at risk of harm. EVIDENCE: The registered manager has left and one of the senior nurses is trying to manage the home as well as direct and supervise the nursing care. She was very clear that her role was a clinical one and recruitment of a suitable manager was needed. The core staff have been in post for some time and have formed a stable team. On the day of the visit there were sufficient nursing and care staff to make sure the residents needs were met. But there was some concerns raised that nursing and care staffing levels were going to be reduced. Memo’s sent by the owner show that he plans to cut staffing hours because of a reduction in occupancy in the home over the last 8 months. Although discussions have taken place between the owner and the CSCI, no agreements to cut staffing Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 23 further have been agreed. While occupancy may be low, the layout of the home is large and people on all three floors use bedrooms at present. This means that all parts of the home have to be cleaned and only one domestic is available to do this between 8:30am and 5:30pm or 9am to 6pm over seven days. These levels have been reduced since the last key inspection in December 2006. There is only one person in the kitchen, which leaves insufficient time for ‘deep cleaning’ tasks and impacts on the standard of hygiene as the cook concentrates the bulk of their time on food preparation and cooking of meals. Only one person is available in the laundry five days a week during the mornings. This means that residents clothing is not washed during other times of the day and not at weekends. If care staff were to be deployed to do these tasks this would take valuable time away from residents care needs. There is no maintenance person specifically employed at Wear Court. An administrator has recently been employed, working sixteen hours a week. One bank nurse’s application form was from previous employment when she was newly qualified in 2002. She left four years ago and returned in 2007.No references, Criminal Record Bureau check, POVA first or check with the Nursing and Midwifery Council had taken place. She has been working as a qualified nurse sometimes as the only nurse in the building. This was discussed with the acting manager who agreed to not use her until she appropriate checks have been carried out. The other file showed that appropriate recruitment procedures had been carried out in the past. There was a completed application form, proof of identity, contract of employment, two good references and Criminal Record Bureau check. Induction records were on file and satisfactory. Training records for Moving and handling, Infection control, Abuse, Health and safety, fire, optical awareness were completed in March 2006. Skin and wound management training was competed January. Supervision is just up to date and records show that they were being done but now starting to be due or just overdue. All staff have National Vocational Qualifications (NVQ) level 2 with three staff currently doing NVQ level 3 Mental capacity act training was completed 5.October 2007. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 24 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): 31,33,35,36,37,38 Quality in this outcome area is poor. This judgement has been made using available evidence gathered both during and before the visit to this service. Overall, management and administration of the service is poor because systems are inadequate and don’t fully support a service that is run in the best interests of people using the service. EVIDENCE: The home does not have a manager in post. One of the senior nurses who has been employed for some time is currently taking on the role as “acting manager”. She was very clear that this was not to be long term nor would she be applying to become registered manager of the home. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 25 Currently there have been no active attempts made to recruit a manager. Internal audits and quality monitoring systems are not being done. The last resident meeting was held on 14.August 2007. The last staff meetings for nurses and carers were held on 17 July 2007 and the last full staff meeting was May 2007. Resident’s personal financial records were satisfactory. A record is maintained for each person’s transactions. Entries were clear with signatures available. A random check of balances and cash were found to be correct. Supervision is just up to date and records show that they were being done but now starting to be due or just overdue. On the day of the visit the administrator was busy trying to make some order of the filing system and records kept in the home. Various files were stacked in a bedroom ready to be reviewed. Some of the records needed for the inspection could not be found and information was stored in a variety of places under different names. Currently it would be difficult for residents to get information or help maintain their personal records. Accidents are recorded but the practice of completing monthly analysis to examine and track trends is not being done. Staff have received training in safe working practices. A plan of how this training is kept up to date is not in place. The fire risk assessment was reviewed in May 2007. Health and Safety policies have not been updated since 2004. Staff were unaware of the risk of choking or aspiration attached to Steradent tablets. It was agreed that they would be locked when not in use and a risk assessment completed. Contract maintenance certificates are available. The certificates to show that the water had been tested for Legionella were not available. The five-year electrical test certificate is dated 2000 but a letter from the owner after the inspection has confirmed that this has since been addressed. As there is only one member of staff in the kitchen is difficult to complete the required cleaning schedules. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 26 The fridges were grimy on the outside. Spillage of liquids and food debris had not been cleaned inside of the fridge. One of the door seals was broken. The extractor fan, water boiler and hot lock trolley have been broken for some time. There was old food spillage over and down the sides of the cooker. The walls and ceiling were not being cleaned on a regular basis and the shelving in the store cupboards did not have easy clean surfaces. The first aid box was incomplete and no blue plasters were available should staff cut themselves. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 27 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 2 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 1 1 2 2 X 1 2 1 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 3 1 1 Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 4,5 Requirement The registered persons must ensure that the statement of purpose is reviewed and up dated. It must clearly set out the aims, objectives, philosophy of care, services and facilities and terms and conditions of the home. The service user guide must be provided to current and prospective residents and be in a format that is suitable for them. Timescale of 28/02/06, 01/04/07 and 01/09/07 not met. The registered persons must ensure that all residents are provided with an up to date contract. When there are any changes a further contract must be issued setting out the terms and conditions including changes to the fee rates. Timescales of 01/04/07 and 01/09/07 not met The registered persons must ensure that social care plans continue to be developed and interests recorded. DS0000064820.V354353.R01.S.doc Timescale for action 01/03/08 2 OP2 5 01/03/08 3 OP12 12,16 01/03/08 Wear Court Version 5.2 Page 29 4 OP15 12,15,16 5 OP16 17,22 6 OP19 13,23 7 OP20 16,23 The registered persons must ensure that the menus offer a choice of meals in written or other formats. Records of food provided must be kept. The registered persons must ensure that there is a simple, clear complaints procedure, which includes the stages and timescales for the process. A record of all complaints made must be kept and must include details of investigation and action taken. The registered persons must ensure that the premises are of sound construction and kept in a good state of repair externally and internally. Timescale of 31/03/07 01/06/07, and 01/09/07 not met. The registered persons must ensure that the dirty, ripped stained lounge chairs are replaced. Suitable dining room chairs and tables must be provided for the assessed needs of the residents. 01/03/08 01/02/08 01/02/08 01/03/08 8 OP21 16,23 Repairs to the conservatory walls must be done to prevent ivy cascading its way into the home. The registered person must 01/03/08 ensure that remedial work is carried out to the damp en-suite wall in room 1. The registered person must ensure that dripping taps, which are lime scale encrusted, are replaced. The registered persons must ensure that the floorings in bathrooms and all toilets are replaced. The registered person must DS0000064820.V354353.R01.S.doc 9 OP21 16,23 01/03/08 Page 30 Wear Court Version 5.2 10 OP22 16,23 11 OP24 16,23 12 OP24 16,23 ensure that all bathrooms and toilets are redecorated within a planned refurbishment programme. Timescale of 01/06/07 and 01/09/07 not met The registered person must ensure that the nurse call bells easily accessible in all resident areas including all bedrooms. The registered persons must continue with the redecoration and refurbishment of the bedrooms. Timescale of 01/06/07 and 01/09/07 not met. The registered person must ensure that out of date information is removed from bedroom doors. The registered person must ensure that worn threadbare carpets are replaced. The registered person must ensure dirty, stained armchairs are replaced. The registered persons must ensure that all lighting in residents’ accommodation meets recognised standards (150 lux). To prevent risk of scalding preset valves of a type unaffected by changes in water pressure and have fail safe devices must be fitted to provide water close to 43 C. The water must be flushed regularly in all unused bathrooms and toilets. Timescale of 01/06/07and 01/09/07 not met The registered person must ensure that water temperatures are checked and recorded before DS0000064820.V354353.R01.S.doc 31/01/08 01/03/08 01/03/08 13 OP25 23 01/03/08 14 OP25 23 01/01/08 Wear Court Version 5.2 Page 31 any resident is bathed or showered. The registered persons must ensure that all rooms can be naturally ventilated. The registered persons must 01/02/08 ensure that liquid soap and paper towels are available in all resident areas to enable effective hand washing. All call cords and light cords must be in easy reach, free from knots and easy cleanable. Suitable bins with lids must be provided to assist with odour and infection control. The walls and floor in the laundry must be impermeable and easily cleanable. Timescale of 01/06/07 and 01/09/07 not met. The registered person must ensure that the sluice disinfector is repaired or replaced Timescale of 01/04/07 and 01/09/07 not met The registered person must ensure that the carpet in the upstairs sluice is removed and replaced with easy cleanable flooring The registered persons must review the practices of leaving toilet brushes in soiled stagnant water. The registered persons must ensure that soiled incontinence pads are disposed of in appropriate clinical waste bags. The registered person must maintain appropriate staffing DS0000064820.V354353.R01.S.doc 15 OP26 12,13,16, 23 16 OP26 12,13,16, 23 01/02/08 17 OP26 12,13,16, 23 01/02/08 18 OP27 18 01/02/08 Wear Court Version 5.2 Page 32 levels to meet the needs of residents as agreed with CSCI The registered person must ensure that there are sufficient kitchen and domestic staff employed so that the home is maintained in a clean and hygienic state, free from dirt and odours. The registered persons must ensure that two references, Criminal Record Bureau checks, proof of identity, and Nursing and Midwifery Council checks are carried out before staff are confirmed in post. The registered person must progress with the recruitment of a suitably qualified manager. The registered person must develop systems that support effective running of the service and in the best interests of residents The registered person must ensure that all records required by regulation for the protection of residents and for the effective running of the business are up to date, secure and maintained in accordance with the Data Protection Act. The registered persons must ensure that Steradent tablets are secured and risk assessments for their use is in place. The registered persons must ensure that all window fasteners are repaired or replaced. This is to enable all windows to be opened. The registered person must ensure that the ivy and copious old bird droppings are cleaned from the outside windows. Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 33 19 OP29 7,9,19 01/01/08 20 21 OP31 OP33 9 24 01/03/08 01/03/08 22 OP37 15,17 01/03/08 23 OP38 13,16,23 01/02/08 The crack in one of the lounge windows must be replaced. The registered person must ensure that the fridges are clean, and the seals replaced. The registered person must replace or repair the broken extractor fan, hot water boiler, and hot lock. The cooker walls ceiling and shelves in the storage room must be cleaned on a regular basis. The registered persons must ensure that the kitchen has a fully stocked first aid box that includes blue plasters RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South Shields Area Office St Nicholas Building St Nicholas Street Newcastle upon Tyne NE1 1NB 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 Wear Court DS0000064820.V354353.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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