Inspection on 11/04/07 for Welland House Care Centre

This inspection was carried out on 11th April 2007.

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

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

Other inspections for this house

Welland House Care Centre 08/02/06

Welland House Care Centre 22/09/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Welland House Care Centre Welland House Lime Grove Welland Nr Malvern Worcestershire WR13 6LY Lead Inspector Yvonne South Unannounced Inspection 11th April 2007 09:20 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 Welland House Care Centre DS0000063986.V332608.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. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Welland House Care Centre Address Welland House Lime Grove Welland Nr Malvern Worcestershire WR13 6LY 01684 310840 01684 310848 elaine.wheeler@redwoodcare.co.uk http:/wellandhousecarecentre.co.uk Welland House Care Centre Ltd 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) Mrs Jeanette Mary Bedford Care Home 51 Category(ies) of Dementia - over 65 years of age (51), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (51), Old age, not falling within any other category (51), Physical disability over 65 years of age (51) Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 08.02.06 Brief Description of the Service: Welland House Care Centre provides accommodation and nursing for 51 older people with care needs relating to old age, physical disabilities, dementia and mental health needs. The home is owned by the Redwood Care Home Group and is managed by Mrs Jeanette Bedford. Welland House is situated in a small village approximately five miles from Malvern. There is a local shop, public house and Church. The home is partly adapted and partly purpose built. It is on two floors and has a passenger lift and appropriately fitted handrails. The home was previously registered as two units but has changed registration in order to offer places for personal care as well as nursing care. The main purpose of the home is to provide a safe comfortable environment where all aspects of residents’ needs are met. In the pre inspection questionnaire completed by the registered manager and returned to the Commission for Social Care Inspection (CSCI) on 26.03.07 it was stated that the range of fees were as follows; Nursing Care: £2628 to £2780 per month and Residential care: £2228 to £2380 per month. Extra charges are made for hairdressing, newspapers, transport, private medication, private chiropody and a TV licence at market prices. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection that incorporated information received by the Commission for Social Care Inspection since 08.02.07 and the information obtained during fieldwork on 13.04.07. The fieldwork took place over eight hours during which the inspector spoke to four residents, four staff and two relatives. Documents were assessed and a partial tour of the premises was undertaken. Prior to the fieldwork the home was asked by the Commission for Social Care Inspection (CSCI) to complete and return a pre-inspection questionnaire and to distribute questionnaires to the residents, relatives and health care professionals seeking their opinions of the service. To date three responses have been received from residents, six from relatives and one from a GP. The focus of this inspection was on the key National Minimum Standards and requirements and recommendations that had arisen out of the previous inspection. What the service does well: The home is positioned in a quiet area with a large attractive level garden that the residents can use. The staff provide good support and care for the people who live there. A relative said that the health care was excellent. Activities were available and people were able to choose if they wished to participate. A resident said that the home could not be better. Staff are described as kind and friendly. The home has a strong commitment to training and this ensures that the knowledge and skills of staff are kept up to date for the benefit of the residents. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (An intermediate service is not provided therefore standard 6 is not relevant) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with sufficient information to help them make a decision regarding admission to the home and care needs are assessed prior to a place being offered, to ensure the home can provide the care needed. EVIDENCE: One resident’s questionnaire response and one other resident confirmed that they had received the information they needed to make a decision regarding admission to the home. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 9 The care records of three people were assessed. They demonstrated that a trained person from the home had undertaken an assessment of the prospective resident’s care needs before they were offered a place in the home. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive the personal and health care they need. Medication is administered safely and people are treated with respect. EVIDENCE: The questionnaire responses indicated satisfaction with the personal and health care provided, as did the residents and relatives who spoke to the inspector. The care records contained care plans relating to the residents’ needs. These were in a tick box format and although acceptable the design was over crowded and the small font made them difficult to read. In addition it was felt that the documents lacked the individuality that is expected and needed in care plans as very few additional comments had been made. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 11 Some facts needed to be clarified or explained, for example one record stated that the resident belonged to two religions, a behaviour care plan did not guide staff on any known triggers, or the responses they should make when needed. Some documents were not named, dated or signed by the author and there was very little information regarding social interests and participation. Detailed life histories for people with dementia were not seen in all of the records. The daily records and those relating to health care professionals were well maintained and indicated good involvement with a range of different professionals. Three residents were bed bound. Some residents were able to walk around the home in safe areas, doors, keypads and safety gates closed off other parts of the home. At one time residents in their rooms were at risk of being disturbed by other residents but the manager said that this was no longer an issue. However their bedroom doors were fire doors and therefore kept closed. It was suggested that sonic door retainers would enable any bedroom door to be held open and still respond to the sound of the fire alarm. This would also provide the residents with a choice and would help to prevent a risk of isolation developing. It was observed that one bed bound resident was well cared for. Music was playing in her room and although there was no response from her she appeared relaxed. Care records indicated that staff frequently went into the room and staff confirmed that they knew her musical preferences and care needs and went in and out of her room and spent time talking to her. Medication was well managed. Storage was acceptable and records well maintained. A hard backed book had been ruled up and was in use as the controlled drug register. It was recommended that this be replaced with a purpose made bound book or register with numbered pages specifically designed and printed for such use. Daily records demonstrated that residents’ responses to medication was monitored and advice was sought when necessary. Residents were observed to be treated in a friendly respectful manner. Privacy and dignity was respected. Personal mail was given to residents who were able to manage. Other post was either dealt with by the home on behalf of the resident, with the resident or forwarded to the relatives according to what had been agreed. Telephone calls could be made and received in private. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 12 Bedroom doors and communal toilets and bathrooms were fitted with approved door locks that had an emergency access facility. Many residents were unable to make a meaningful contribution to their care plans and reviews. In such circumstances, and with the resident’s consent, the family should be involved and records maintained. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to follow their individual religions and partake of a varied menu and choice of activities giving them a good quality of life. EVIDENCE: The home employs a full time activities co-ordinator. The pre-inspection questionnaire completed by the manager stated that in-house activities, and outings took place in the community visiting local churches each month and occasional village activities. A violinist entertained the residents in the home once a month. The three residents who completed the questionnaires stated that there were usually activities arranged. One person said that the lady who did the activities had been ill recently. The other staff were endeavouring to cover her duties while she was away. Everyone had enjoyed an evening of bowling that week. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 14 Samples of a varied and balanced menu were seen. The manager said that due to many residents with short term memory problems the choice was offered close to the time of serving and alternatives were offered if the resident said or did not appear to be enjoying their meal. The three questionnaires returned by residents said that they liked the meals that they received. This was confirmed by a resident who spoke to the inspector, and a relative complimented the food. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. People are aware how to raise their concerns and they are addressed. Good staff recruitment and training protects the people who live in the home. EVIDENCE: Since the last inspection the CSCI had received two complaints, which had been referred to the provider/manager for investigation. One had concerned the management of a resident whose behaviour was of concern. The investigation revealed that the home was working with health care professionals to resolve the situation as quickly as possible and staff were receiving appropriate training so they could cope. The second concern was related to residents who were bed bound and stayed in their rooms all the time with the doors closed. At the time the concern was raised the doors were locked. However it should be noted that residents were not locked in. They could leave at any time if they had the ability. Unwanted visitors were locked out so that the occupant was not disturbed. The manager said that there are no longer residents who wandered in the areas where residents were bed bound and therefore the doors were no longer locked. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 16 However it remains of concern that the closed doors could lead to a sense of isolation, regardless of the fact that staff confirmed that they frequently visited and spent time with the residents. The manager was aware that the bedroom doors were fire doors and must not be wedged open. Therefore it is strongly recommended that the home obtain some sonic door retainers so that residents can have their door held open in safety if they wish. The home records demonstrated that they had received two complaints. One had concerned some missing laundry and spectacles. This had been resolved. The other had concerned the missing key to the courtyard. This had been found and a spare was now available. All questionnaire responses indicated the respondents were aware how to raise their concerns. The staff who spoke to the inspector were aware how to respond to concerns. The staff confirmed that they had undergone an acceptable recruitment procedure and their records demonstrated that references had been taken up and checks had been made with the Criminal Records Bureau (CRB) and against the Protection of Vulnerable Adults list (PoVA). Staff and their records confirmed that they were receiving appropriate training and were aware how to respond to allegations or suspicions of abuse. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some of the environment is poorly maintained so that residents do not have a pleasant place in which to live. Health and safety is compromised by damaged furniture and fittings. EVIDENCE: A partial tour of the home was undertaken. It was observed that several vanity units around hand basins were worn-out and ill fitting. The wood veneer was broken and posed a health and safety hazard. In some bedrooms there were insufficient electrical sockets and trailing wires posed a risk to residents, especially those with dementia. Some carpets and armchairs were stained and looked grubby although there were no offensive smells and it was apparent that efforts had been made to improve their appearance. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 18 A table had broken veneer and a commode with chipped enamel was seen. The décor was tired, torn and worn in places. Overall the impression received was of slow progress in maintenance and investment despite the fact that the manager said in the pre-inspection questionnaire that that the top corridor was in the process of redecoration and refurbishments had commenced to the dining room, and some bedrooms. The handyman was employed to work for 20 hours a week and was responsible for minor decoration and repair tasks, garden maintenance, general maintenance, health and safety checks of fire systems and equipment, water temperatures and lighting. This would appear to be an unmanageable workload for a home of this size in the time available. Four requirements had been made in the previous report concerning the premises. 1. The outer kitchen floor must be attended to. It was seen that this had been attended to but the covering had not been robust enough. New floor covering was about to be fitted through the kitchen area, which would improve the health and hygiene aspects. 2. All bolts must be removed from the outside of doors and keypad locks fitted The manager pointed out where keypads had been fitted. There was one more bolt to be removed from a sluice door and replaced with a keypad lock. 3. Toilets and bathrooms must be refurbished It was observed that the four main toilet areas had been redecorated but the impression was spoilt in some rooms by damaged furniture. 4. The ceiling identified during the inspection must be repaired. This had been done. Communal toiletries were no longer used and products such as bubble bath and shampoo were stored securely. The laundry was well equipped and personal protective equipment was appropriately placed around the home. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient staff are recruited and trained so that residents receive the care and support that they need. EVIDENCE: The home had a large number of staff from other countries. However the manager confirmed that there were no language difficulties and three people were taking English lessons. The requirements of different faiths and cultures were acknowledged and supported when necessary. Questionnaire responses indicated that residents and their relatives considered that appropriate care and support was given and staff were responsive and always available when needed. Two questionnaire responses indicated an anxiety over staffing levels. Thirty-four staff had left the home’s employment in the past year. Three of these people had been found unsuitable. The others left for a variety of reasons. Recruitment for replacements had taken place and there was currently further recruitment underway. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 20 Fifteen trained nurses were employed and thirty-three care staff. Fifty percent of the care staff had National Vocational Qualifications (NVQ) to level two or above. The pre-inspection questionnaire indicated that a wide range of training had taken place in the past twelve months and more training was planned for the future A training matrix identified who needed training and who needed training updated. The manager confirmed that individual training records were being developed. Both the manager and the deputy were moving and handling trainers and staff’s knowledge and skills were updated by them. Staff records demonstrated that an acceptable recruitment process was used and training records confirmed that staff received both training and individual supervision and support. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care is well managed and health and safety is addressed to ensure the well being of everyone in the home. However some weaknesses in the maintenance of the property have resulted in an increase in the level of risks. EVIDENCE: The home is well managed by an experienced, competent and well-trained manager who was registered by the CSCI in May this year. She is supported by a deputy and a team of trained nurses. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 22 The organisation has a Quality Assurance manager who visits the home each month and monitors the quality of the service provided. The manager said that monthly samples of questionnaires were made available to her and in addition audits were undertaken on a range of areas such as medication, infection control and catering. A copy of the Quality Assurance Annual Review and plan were submitted to the CSCI. The administrator said that no personal monies were kept for residents in the home. Invoices were raised for all personal expenditure such as hairdressing, private chiropody and toiletries. Documentation demonstrated that risk assessments were in place for the home. Chemicals were appropriately stored and staff had received training in health and safety subjects. Accident records were well completed. An external fire safety trainer visited the home and undertook training with the staff twice a year. The courses were mandatory and each time the staff were given a choice of three dates to ensure total attendance. The manager was advised that the Hereford and Worcester Fire Authority recommended that staff received updates every three months and participated in at least one fire drill each year. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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 OP38 Regulation 13, Requirement Unnecessary risks to health and safety of residents should be identified and as far as possible eliminated. The premises should be kept in a state of good repair. Timescale for action 01/11/07 2 OP19 23 01/04/08 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 OP38 OP9 OP7 Good Practice Recommendations Sonic door retainers should be available for residents who stay in their rooms. A controlled drugs register, printed for the purpose, with numbered pages, should be used. Residents, or with their consent their supporter, should be involved in their care planning. Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 25 4 OP19 A full audit of the premises should be undertaken and a programme of routine maintenance and renewal of fabric and decoration be discussed with the manager, produced and implemented. The guidance provided by the Hereford and Worcester Fire Authority in relation to the frequency of fire safety training and drills should be implemented. 5 OP38 Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Welland House Care Centre DS0000063986.V332608.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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