This inspection was carried out on 18th July 2005.
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.
CARE HOMES FOR OLDER PEOPLE
The Weir Nursing Home Swainshill Hereford Herefordshire HR4 7QF Lead Inspector
Sandra Bromige Unannounced 18 July 2005 10:50 hrs 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. The Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Weir Nursing Home Address Swainshill Hereford Herefordshire HR4 7QF 01981590229 01981 590445 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) Mrs Christine Juul Allen Mr DA Kingham CRH Care Home 35 Category(ies) of DE Dementia 35 registration, with number DE(E) Dementia - over 65 35 of places OP Old Age 35 PD Physical disabillity 35 PD(E) Physical disability over 65 35 TI Terminally Ill 35 The Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This Home provides care for residents aged 60 years and over. 2. This Home provides specialist care for Parkinsons Disease sufferers. 3. The Registered provider shall carry out the requirements of the local authority, planning department, building control and environmental health (together called the associated bodies) in respect of the extension and until the associated bodies have indicated their satisfaction of due and satisfactory completion to the registered provider, it shall admit no more than 31 service users. 4.. The Home may continue to admit service users with the categories DE and DE(E) provided that dementia is not of such severity as to render such service users either, as a danger to themselves or others. Date of last inspection 12 October 2004 Brief Description of the Service: The Weir care home is situated in the village of Swainshill 4 miles from Hereford. The Georgian property is leased from the National Trust and managed by The Weir Nursing Home Ltd. It is set in attractive gardens adjacent to the Weir National Trust gardens with extensive views over the River Wye and surrounding countryside.It is a care home with nursing currently registered for a maximum of 35 service users of both sexes over the age of 60 years. Categories of care offered are physical disability; terminal illness, dementia and specialist care for Parkinson’s Disease sufferers. The Home was registered in 1995 and consists of a two and three-storey building.The Home has 15 single bedrooms, 5 have en-suite facilities. 4 double bedrooms, all without an en-suite facility. The Home has a further two multiple occupancy rooms. The Provider intends to phase the multiple occupancy bedrooms out once the extension to the rear of the property is completed (subject to registration approval). There is a passenger lift to all floors of the Home. The Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced inspection took place over 6 hours on the 10th May 2005 by two Inspectors. During this inspection serious concerns were found. The concerns were about the failure of the Home to provide appropriate care and equipment for identified people and the Home were also failing to protect all of the residents in the Home as they were not following thorough procedures when employing new staff. These concerns were shared with other agencies responsible for the care of residents in the Home through using local Herefordshire procedures for the protection of vulnerable people. After consideration of the information gained at the inspection, multi agency arrangements for the protection of vulnerable people were put in place and a decision made that no further admissions would be made at the home until practices had improved and satisfaction agreed by all agencies. The Commission sent a letter to the owners of the Home telling them of the serious concerns and this was followed by a meeting with them and then sending 5 Enforcement Notices telling the owners the action they needed to take to improve the standards of care practice, equipment to be provided and information that needed to be obtained before staff were employed. The Home was given a set period of time to put into place the required changes. The owners of the Home have been very co-operative with the Commission and recognised the seriousness of the concerns. An unannounced inspection took place over 6 hours on the 18th July 2005 by two Inspectors to check if the Home had taken the action needed to improve the standards in the areas noted in the 5 Enforcement Notices. The Inspection found that the vast majority of requirements contained in the five enforcement notices to have been complied with, a small amount of work being required to meet full compliance. A number of records were inspected. Residents were seen, and the manager (designate) and some nurses and care staff and one visitor were spoken with. What the service does well:
People are able to live in a Home that is set in beautiful countryside with views across the River Wye. The gardens are very large and are well looked after. The Home is kept clean and there are no bad smells. Residents are well dressed and their clothes are nicely laundered. The staff are very pleasant and cheerful with residents and visitors to the Home. The Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
All of the information listed on the Home’s pre-admission assessment form needs to be obtained and recorded after visiting the person before a decision is made for a resident to be admitted to the Home. Care planning needs to improve further to ensure that staff know what to do for each resident. The care plans need to be discussed with the resident and/or their next of kin to ensure that they agree with the care needs identified. Opportunity for residents to exercise, engage in any interests and activities and to go out into the community need to be provided by the Home on a regular basis. Appropriate door locks need to be provided on all bedroom doors in the Home. Work on updating all the staff records needs to be completed and the staff files all need to be properly collated. The information obtained when recruiting new
The Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 Stage 4.doc Version 1.40 Page 7 staff still needs to be improved. The owners need to develop a system, which allows them to assess the standard of the service given by the Home. Care staff need to have regular supervision and this information needs to be recorded. Staff need to be sent for training to make sure that a first aider is in the Home at all times. All staff need to receive fire training at regular intervals to make sure that they know what to do in the event of a fire in the Home. 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 Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Thorough assessments are not being done by the Home prior to admission of the resident to ensure that the resident’s care needs can be met and to form the basis of the plan of care. EVIDENCE: The records of a recently admitted resident contained an assessment completed by the Home prior to admission. All parts of the assessment form were not completed and medication noted as being taken by the resident was not on the residents current Medication Administration Record. The Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 Progress has been made on improving arrangements to ensure that the health care needs of residents are identified and met. Further progress is now needed to ensure that there is no shortfalls in identifying residents care needs that may potentially place them at risk. EVIDENCE: New records are being used for recording the residents care needs and care given by the Home. The standard of the recording in the care plans has much improved, but further improvement is needed. The sample of records seen during this visit had parts of the care plan where information had not been competed at all. More information is needed to make sure that the care staff know what to do for that resident. All aspects of the care plans had not been reviewed each month. Care plans had not been discussed and agreed by the resident or their nominated representative. Specialist equipment is provided by the Home for the prevention of damage to residents skin from pressure whilst lay in bed or sitting in the chair. The Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 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 Social activities are not being provided by the Home in sufficient regularity to provide exercise, stimulation and interest for the residents living in the Home. EVIDENCE: The Home has a part time activity organiser in post. A new activity person was appointed in July for a further 15 hours but has since left the Home. Social care plans are not actively in use at present. The activity person keeps a diary of any activities that take place. These records show that the current activities are very limited in variety and availability. The Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 Stage 4.doc Version 1.40 Page 12 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) EVIDENCE: The Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 Stage 4.doc Version 1.40 Page 13 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) EVIDENCE: The Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 Stage 4.doc Version 1.40 Page 14 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 deployment and numbers of staff are sufficient to ensure that the residents physical care needs are met. There are not sufficient staff to ensure that the recreational care needs of residents are being met. Recruitment practice has improved but is still insufficiently thorough to ensure that all staff appointed are suitable. Staff records do not provide a complete picture of the experience and training of the staff team. EVIDENCE: On the morning of the inspection there was 1 registered nurse and 6 care staff and in the afternoon there was 1 registered nurse and 4 care staff. In addition to these there was the Manager (designate) and the Clinical Manager providing further administration and clinical support. A member of staff has been delegated the task of reviewing and updating all the staff records. There was still a lot of work to be done to complete this and information was awaited from some of the staff concerned and from the manager (designate). The records for recently appointed staff showed that staff are not starting work until a POVAfirst check has been received. However the records for three recently appointed staff showed that no references had been received for one and her CV and a letter from her to the manager (designate) were not in English. Testimonial style references had been accepted for the two other people. The Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 Stage 4.doc Version 1.40 Page 15 Three of the staff records looked at contained contradictory information about the position the individuals had been appointed to. Some documents referred to them as Adaptation Students but others referred to one of them as a care assistant and the others as senior care assistants. The Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 Stage 4.doc Version 1.40 Page 16 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) EVIDENCE: The Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 Stage 4.doc Version 1.40 Page 17 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 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 2 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x The Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 Stage 4.doc Version 1.40 Page 18 Yes 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 3 Regulation 14 Requirement A detailed pre-admission assessment for all residents must be carried out to show consideration of all elements of Standard 3.3. TIMESCALE OF IMMEDIATE & ONGOING NOT MET Care plans must be further developed to ensure that all areas of the care plan format are completed and evaluated on a monthly basis. Care plans must be developed and reviewed in discussion with the resident and/or their next of kin, to ensure that they agree to the content. The registered person, having regard to the needs of residents and in consultation, must provide in relation to recreation and exercise. TIMESCALE OF 31/01/05 NOT MET. Bedroom door locks must be provided for all doors. BROUGHT FORWARD NOT ASSESSED Work on updating all staff records must be completed. As part of this work the post for which each person is employed must be confirmed. Timescale for action Immediate & ongoing 2. 7 15 30/09/05 3. 7 15 30/09/05 4. 12 16 30/09/05 5. 6. 24 29 12, 13 17 & 19 31/03/05 30/09/05 The Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 Stage 4.doc Version 1.40 Page 19 7. 29 17 & 19 8. 33 18 9. 36 18 10. 38 13 11. 38 23 The Homes recruitment process must be further improved to comply fully with the requirement to obtain references before a person starts work at the . The Provider must develop a system to monitor and audit the quality of service delivered by the Home. BROUGHT FORWARD NOT ASSESSED. The registered person must ensure that care staff receive formal supervision. BROUGHT FORWARD NOT ASSESSED The registered person must ensure provision of a qualified first aider at all times. BROUGHT FORWARD NOT ASSESSED All staff must receive suitable training in fire prevention. BROUGHT FORWARD NOT ASSESSED Immediate and ongoing. 31/03/05 28/02/05 31/01/05 31/12/04 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations The Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection 178 Widemarsh Street Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 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 The Weir Nursing Home E52 E02 S27692 The Weir Nursing Home V241021 180705 Stage 4.doc Version 1.40 Page 21 - 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!
