CARE HOMES FOR OLDER PEOPLE
Weatherstones House Nursing Home Chester High Road Neston Wirral CH64 7TD Lead Inspector
Gill Matthewson Announced 5 September 2005 9:30 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 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. Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Weatherstones House Nursing Home Address Chester High Road Neston Wirral CH64 7TD 0151 336 8383 0151 353 0563 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Weatherstones House Care Ltd Mrs Jayne Beard Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) Both of places Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1 This home is registered for a maximum of 31 service users in the category OP (Old age, not falling within any other category) 2 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The registered manager must attain an NVQ Level 4 in Management by 31st December 2006 Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection 3 4 Date of last inspection 3 May 2005 Brief Description of the Service: Weatherstones House is a large sandstone detached property which is a listed building and is set in two acres of grounds. It is situated on the A540, close to the village of Willaston and the town of Neston. A private drive leads to the house and there are good parking facilities. Accommodation for residents is on two floors, with a passenger lift providing access to the first floor. In certain areas ramps have been constructed to provide access to rooms which are on different levels. A large basement houses the laundry, kitchen storage, and a repair and maintenance facility. On the ground floor there are two lounges, a conservatory and a dining room. The ground floor also has 11 bedrooms, an office, nurses station and the kitchen. The first floor has a small sitting area, 13 bedrooms and the clinical room. There are assisted toilets and bathrooms on both floors and a nurse call system and fire alarm system are installed throughout.The home is registered to provide nursing care to frail older people and is staffed by registered nurses at all times. The home also employs care assistants, administration, domestic, kitchen and laundry staff, and a maintenance person. Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The lead inspector spent two hours planning the inspection by reviewing previous inspection reports and the service history over the last twelve months. The inspection took place over five hours and included a tour of the building, inspection of records and discussion with six residents, five members of staff and a visitor. Feedback was given to a company representative, the registered manager and the deputy manager of the home. What the service does well: What has improved since the last inspection?
Pre-admission assessments are fully documented and held in residents’ care files to provide registered nurses with the information they need to formulate a care plan. A weekly activity programme is now in place to provide some social stimulation for the residents.
Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 Page 6 Stains have been removed from bedroom carpets and the home has achieved a gold award for hygiene in the kitchen. Staff are all receiving fire safety training on a regular basis. 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. Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Residents have their needs assessed prior to admission to ensure that the home will be able to meet those needs. EVIDENCE: Three care files were reviewed. All residents had been visited by the home manager and a full assessment carried out prior to admission. Details of preadmission assessments and copies of care management assessments were contained in the files. Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7, 8 & 9 There is a care planning system in place, which, in the main, provides staff with the information they need to meet residents’ needs. The health needs of residents are well met, with evidence of good multidisciplinary working taking place on a regular basis. Medicine policies and procedures ensure that, in the main, residents receive their prescribed medication. EVIDENCE: In the main, care plans were in place detailing the actions needed to be taken by staff to ensure that residents’ needs were met. In two of the three files reviewed, some minor additions were necessary. For example, one resident sometimes needed the use of a hoist for transferring, but the care plan did not specify which hoist. The resident also needed dressings to a leg ulcer, but the care plan did not specify how often the dressing needed to be changed. Another resident had been seen by the GP because of weight loss and food supplements were being given, but there was no written care plan in place. See Recommendation 1. Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 Page 10 The home had an allocated GP who visited the home twice a week. Care files contained evidence that residents were able to consult with other health care professionals as required, for example chiropodist, community psychiatric nurse, optician. Residents were assessed as to their risk of developing pressure sores and appropriate equipment was provided. Nutritional assessments were carried out. Residents had been assessed by the continence nurse and the appropriate aids supplied. Residents spoken with were satisfied with the health care that they received and there was evidence that their personal hygiene needs were met by care staff. There was a clinical room on the first floor which was found to be clean, tidy and well organised. Policies and procedures were in place describing all aspects of the medication process. None of the residents were self-medicating but an assessment document was available for any future resident who may wish to self-medicate. Medicines were only administered by registered nurses. Five medication administration record (MAR) charts were reviewed. There were a few gaps on the MAR charts with no explanation as to why the medication prescribed at that time had not been administered. However, generally these were in relation to laxatives that may not have been required. One gap was for a sleeping tablet and one was for an antidepressant. It was also noted that one resident’s eye drops, which had a shelf life of 28 days from opening, had not been marked with the date they were opened. See Requirement 1. Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12, 13, 14 & 15. Improvements have been made in the range of recreational activities available, but further development is needed to ensure that the home meets residents’ needs and preferences. Residents are able to maintain contact with loved ones and exercise control over their lives. Their dietary needs are well catered for with a balanced and varied selection of food available that suits residents’ tastes. EVIDENCE: Residents spoken with were satisfied that daily living routines were appropriate to their individual needs. There was a choice of two lounges and a conservatory to sit in, and a small number of residents preferred to spend their time in their own room. The deputy manager had responsibility for organising activities for the residents. A file was kept of activities that had taken place and who had participated. In the previous week there had been a visit from the hairdresser, two keep fit sessions, ball games, bingo, giant crosswords and reminiscence. Some residents had also paid a recent visit to the local garden centre. Residents said that they had been consulted about the activity programme and there was more to do than previously, but some residents said that their interests lay in individual pursuits such as sewing, knitting and gardening. See Recommendation 2.
Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 Page 12 Residents and a visitor spoken with confirmed that residents are able to have visitors at any reasonable time and may receive them in private. The home had satisfactory policies in place that stipulated that residents were to handle their own financial affairs for as long as they wished and were able to do so. There was also information for staff, residents and relatives on local advocacy services. Residents could bring small items of furniture and other possessions into the home to personalise their own room. Residents spoken with at this inspection and on previous inspections expressed their satisfaction with their meals. Three full meals a day were offered including a cooked breakfast, and a choice was available at each meal. Night staff were able to make snack meals if a resident wanted something to eat during the night. Lunch on the day of inspection consisted of hotpot or liver and sausage with mashed potatoes and peas, followed by apple pie and custard. Tea consisted of soup and a pastie or sandwich. Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 Page 13 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 standard(s) 16 The home has a satisfactory complaints system with some evidence that residents’ views are listened to and acted upon. EVIDENCE: The home had policies and procedures for dealing with complaints. The complaints procedure was displayed in the entrance area. The complaints log was reviewed. However, there had been no complaints since the last inspection. Residents spoken with said they would speak to the manager if they had any concerns. Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 Page 14 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 standard(s) 19 & 26. In the main the home provides a pleasant, comfortable environment although furnishings need to be reviewed in some bedrooms and planned maintenance or renewal undertaken so that a good standard is maintained. EVIDENCE: A tour of the home showed that the home was generally well-maintained and adequate bedroom furniture was provided. Carpets were much cleaner than at the previous inspection in May. A few items of bedroom furniture were damaged, for example in room 25 the metal commode frame was rusting, in room 24 the veneer of the portable table was damaged, in room 13 the metal frame of the commode was rusting and the bedside cabinets needed revarnishing or painting and in room 15 the carpet was worn and ripped under one of the beds. See Requirement 2. The upstairs corridor walls were badly marked. The handyman said this was next on his list for redecoration. The carpet was also stained in places. See Recommendation 3.
Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 Page 15 The home had recently achieved the Gold Award from the Environmental Health Department for hygiene in the kitchen. Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 The numbers and skill mix of staff ensures that residents’ needs can be met. The procedures for the recruitment of staff are robust, providing safeguards to offer protection to people living in the home. EVIDENCE: At the time of the inspection there were 19 residents, all requiring nursing care. The home provided two registered nurses and three care assistants from 8am to 2pm, one registered nurse and three care assistants from 2pm to 8pm and one registered nurse and two care assistants overnight. These numbers were sufficient to meet the needs of the residents. Three staff files were reviewed. All the required information and documentation was obtained prior to employment. Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 37 & 38. The systems for resident consultation are good, with evidence that indicates that residents’ views are sought. Arrangements to ensure the health and safety of residents and staff are satisfactory. EVIDENCE: The registered provider has made arrangements for a director of the company to visit the home on a monthly basis and prepare a written report on the conduct of the care home. These reports were available for inspection. A resident survey had been recently carried out and 17 responses had been received. All apart from one were positive. The home manager held regular meetings with residents and relatives, one being planned two days after the inspection. Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 Page 18 The standard of record keeping in the home was found to be generally good and records were maintained in accordance with the Data Protection Act. Notifiable incidents were reported to the Commission for Social Care Inspection. All staff received training in safe working practices on induction and updates were provided as necessary. The fire log book demonstrated that fire systems were tested and serviced at the required intervals, that staff had received fire safety training and that eleven fire drills had been carried out this year at varying times of the day. The home provided a good selection of moving and handling equipment and staff were trained in how to use it. All residents were assessed for their needs in relation to moving and handling. The home manager carried out a monthly audit of any accidents in the home. Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 3 x x x 3 3 Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 Page 20 NO 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 OP9 Regulation 13(2) Requirement The registered person must ensure that eyedrops are dated on opening and explanations for non-administration of medication are documented on the MAR chart. The registered person must make good or replace the bedroom furnishings identified. Timescale for action 05.09.05 2. OP19 16(2)(c ) 31.12.05 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 OP12 OP19 Good Practice Recommendations Care plans should be specific in relation to type of equipment, frequency of dressings etc. Staff should consult with residents with a view to devising individual activity programmes. Replacement of the upstairs corridor carpet should be included in the homes planned maintenance programme. Weatherstones House Nursing Home F51 F01 S18819 Weatherstones V240094 050905 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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