Inspection on 20/11/08 for Wellington House

This inspection was carried out on 20th November 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Wellington House Finborough Road Stowmarket Suffolk IP14 1PW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sarah Buckle     Date: 2 5 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Wellington House Finborough Road Stowmarket Suffolk IP14 1PW 01449774633 01449775035 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Healthcare Homes Limited care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The Registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accomodated is: 21 Date of last inspection Brief description of the care home Wellington House is a large converted and extended listed period house, situated on a main road near the centre of Stowmarket. It has been by owned by Healthcare Homes since June 2008 and provides care and support for up to 21 residents who are older people or who have dementia. The home has 11 single rooms and 5 double rooms; 7 rooms have en suite facilities. Resident accommodation is on two floors, the upper floor being accessible by stairs or stair lift. There is a communal area available to service users on the lower floor, with a dining area, also on the lower floor. There is currently extensive building work being undertaken as a two-storey extension is being built to the rear of the home. The home is situated within a 5-minute walk of the Care Homes for Older People Page 4 of 35 5 0 Over 65 0 21 Brief description of the care home centre of Stowmarket, where there is a wide range of shops, pubs and public amenities, including library and post office facilities. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was the first unannounced key inspection at Wellington House since it was registered under new providers Healthcare Homes in June 2008. The inspection focused on the core standards relating to Older People. It took place over 2 days and lasted 9 hours. The inspection process included a site visit to the service, a partial tour of the premises, speaking with residents and the care staff that support them. The manager was present on the second visit to the home. The process also included observations of staff and resident interaction, and the examination of a number of documents including residents care plans and associated documents, medication records, the staff rota, recruitment records, training records, menus and documents relating to health and Care Homes for Older People Page 6 of 35 safety. 4 resident surveys and 4 staff surveys were completed and returned to the Commission. The report has been written using accumulated evidence gathered before and during the inspection. The Commission received a completed annual quality assurance assessment (AQAA) in October 2008. What the care home does well: What has improved since the last inspection? What they could do better: The recording of the initial assessment process could be more detailed to provide comprehensive information about the person concerned. Thorough initial assessments could translate directly into comprehensive care plans which detail all of the actions that staff need to take to ensure the holistic needs of the residents are met. Wellington House could promote and enable activities and routines that are chosen by the residents individually and which are meaningful to them. Complaints and safeguarding procedures are in place, however, all residents or their representatives must be made aware of how to make a complaint and all of the staff team should complete training in the safeguarding of vulnerable adults. The manager must ensure that all core training is completed and specialist training undertaken by all staff members particularly training in dementia and challenging behaviour as the home is registered for older people and those with dementia. Care Homes for Older People Page 8 of 35 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager at Wellington House understands the importance of providing sufficient information for people to make an informed choice about deciding to live at the care home. Pre-admission assessments are completed and these are, in the main part satisfactory. Prospective residents are given appropriate opportunity to spend time at the home prior to deciding to live there. Evidence: The statement of purpose was examined during the inspection and this was a comprehensive document containing all of the specified information. The document included a summary description of the care home and the accommodation. This had been recently updated to include information about the major redevelopment and building works currently being undertaken at the premises and stated The building works have been carefully planned and scheduled so as not to interfere with the existing home. During the site visit to Wellington House it was positive to note that Care Homes for Older People Page 11 of 35 Evidence: the building works were not obtrusive. The admission procedure is clearly identified within the statement of purpose and includes a preliminary visit to the service in order to get the feel of the home. A one month trial period is part of the admission process. The service user guide was also examined and this was in the form of a question and answer sheet i.e. What is Wellington House?, Who will care for me?Can I bring my own possessions? etc. The annual quality assurance assessment completed by the manager of the home states in the what we do well section of this outcome group, Provide a comprehensive set of documents prior to any admission not only to any prospective resident but also to family, friends or social workers. This ensures that everyone has the same comprehensive information available about Wellington House and what we can offer. We also issue copies of the latest report and advise families and residents how to access the CSCI website to see other homes reports and information. In order to assist them with their choice of home. We also encourage visits to the home, sharing a meal, staying for a day in order that they may all see what we do and how the home operates..... Two personal care plans were examined in depth in relation to assessment. One resident had a Potential Resident Assessment which had been completed on 13/11/2008, which was prior to their admittance to the home on 17/11/2008 in line with the national minimum standard. The assessment contained the residents personal information, preferred name, next of kin, GP details and current medication. Their past medical history also included detailed urinary tract infections (UTIs) which made the person prone to falls, it also detailed constipation and hearing difficulties. An assessment tick chart was also completed which asked what help was needed. This outlined that the person required help with walking (1 carer), the use of a zimmer frame for mobilising and walks with staff. The assessment stated that the potential residents hearing was good, which is contrary to earlier information, vision was good, speech was clear and mental state was lucid. The section concerned with history of falls said Prone to falls when (they have) a (urinary tract infection) UTI. The care plan also contained a Discharge Checklist and Summary completed by Suffolk NHS. This included a physio therapist summary UTI treated. Mobility with frame and supervision of 1 x person; and OT summary Struggling to cope with washing and dressing needs assistance with all aspects of daily living and a nurse summary UTI recurrent. MRSA in urine..... Care Homes for Older People Page 12 of 35 Evidence: The second care plan examined did not have a Potential Resident Assessment in place, it did however contain discharge information from Suffolk NHS to the home which stated that (the resident) dislikes people invading his personal space - this can cause (the resident) to become angry, which in turn could result in (the resident) displaying either verbal/physical aggression towards others. All of this information outlines the specific needs of the individual and this information should translate directly into care and support plans to enable staff to know what actions to take to support the individual, however, the information gained during the initial assessment and pre assessment stage did not always translate clearly into the plan of care for daily living of the resident. For example, for one resident there was no information for staff to look for triggers or symptoms that might be due a UTI. Four resident surveys were completed and returned to the Commission, all of these stated that they received enough information about the home before they moved in; 3 people said that they always receive the care and support they need and 1 person said that they usually do. Further assessments of the individual were undertaken in specific areas on a monthly basis and this updated information obtained about the person at their initial assessment. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans at Wellington House include basic information regarding the support needs of the people that live there, but are not sufficiently detailed or person centred. The care plans are reviewed regularly but the information does not translate into a comprehensive plan of care. Risk assessments although completed for some areas of risk are not all adequately individualised or person centred. The health needs of residents are monitored and appropriate intervention sought, however, support plans regarding the health needs of individuals are not adequately completed. Medication is well managed. Evidence: Two care plans were sampled at random during the site visit to Wellington House. One of these was looked at for a second time on the second visit. Although these were completed in some detail, the information contained did not present a comprehensive picture of the action care staff would need to take in order to meet all aspects of the health, personal and social care needs of the residents. Care Homes for Older People Page 14 of 35 Evidence: The care plan for the newest resident was examined. The care plan was well laid out and clearly indexed. It was positive to note that it included the residents personal information, GP details, next of kin details, preferred funeral arrangements, a transfer record in case it was needed, a physical description of the resident, a missing person form completed in case needed and an admission record. The residents personal profile had been completed, and there were details of their likes and dislikes in relation to social and leisure activities. The residents wishes were outlined which included a list of tasks such as management of finances, medication, preparing own drinks and snacks, personal shopping, care of own room etc. There was an assessment of the residents ability to manage any of these, which stated (The resident) is unable to do the above safely, however there was no reason given as to why this was considered to be the case. The care plans were devised from monthly assessments. For example, getting up and going to bed was assessed as requires daily oversight and bathing was manages with physical assistance, dressing/undressing was manages with physical help. The manual handling assessment which was completed to be used along side the assessment stated in relation to getting out of bed clear step by step instructions. 1 x carer. Zimmer frame, however it did not detail what the clear step by step instructions should be for this individual resident. The bathing section stated clear step by step instructions. 1 x carer. Ambi bath. Again the actions that staff need to take for the individual were not detailed or specific. The physical health assessment detailed that the person had substantial hearing loss and stated see hearing assessment, however there was no evidence of a hearing assessment in place and consequently no information relating to what actions the staff team would need to take in order to support the person. For example, whether the person wore an aid, what type, where it was kept, whether eye contact needed to be made when talking to them, lip reading etc. The diet assessment stated normal and feeding stated manages alone see diet assessment. The diet assessment was completed in some detail and gave a clear indication of what the individuals needs and requirements were i.e. no specific needs or preparation, prefers small meals, needs encouragement to drink fluids and (The resident) is not a very big eater, he prefers to have small meals. He doesnt have a sweet tooth so quite often he will refuse a dessert. (The resident) also needs encouragement to drink fluids. The assessment for this resident identified that they suffered from constipation, and the support advice stated (The resident) is prone to constipation and can become impacted and is on medication for this. This does not detail what actions staff could take to support the resident and what signs and symptoms to be aware of regarding this. Care Homes for Older People Page 15 of 35 Evidence: A second care plan examined contained a description of the resident, an admission record, personal profile and information on goal setting which stated (The resident) does not wish to set any goals but does wish to take part in any activities. Ask (the resident) daily to give (them) a choice. The care plan contained a monthly assessment regarding personal care. It was positive to notice that any changes in the needs of the resident were recorded in the assessment i.e. that assessment regarding toileting changed from can manage on own but not always in the appropriate place to needs verbal prompting, requires equipment and help and not always in the appropriate place. However, there was no specific care plan in place in relation to this information explaining the detail such as what kind of verbal prompting, when, what equipment is required, how would staff enable the resident to use the appropriate place for toileting etc. A care plan for bathing stated (The residents) short term memory does affect (their) ability to bath safely prefers bath, The resident needs gentle reminding to cleanse all parts of their person and the resident does like to use products which smell nice. On the second visit to the service this had been updated and contained significantly more detail i.e.the resident does like to use products which smell nice. They do not readily bathe and will become agitated when approached to bathe.... When this happens try reassuring (the resident). (often the best time for the resident is early morning). If this is to no avail, come away from the situation and try again later or ask a colleague to try. The initial information did not detail that the resident might become agitated or what action staff should take to support the person. Falls assessments were completed as part of the care planning process as were nutrition assessments and pressure care assessments. For one resident who was deemed to be high risk for both of these there were no clear individualised management plans in place i.e. at the first site visit, the generic information for high risk residents on the falls assessment stated ensure resident is observed at all times and physically assisted when mobilising. During the course of the inspection the resident was observed shuffling unattended along the corridor, holding on to a grab rail. The resident looked very unsteady of their feet. In discussion, the administrative manager stated that the resident was observed from a distance on a good day. This information was not recorded in the care plan, nor was there information about what constitutes a good day or a bad day. The manager stated that on a good day the resident could walk. The same resident was considered to be at high risk of pressure sores, however there was no plan in place regarding how this should be managed i.e. what the staff should look for and what action they should take. It was positive to note that on the second visit the assessments had been updated and a new document Care Homes for Older People Page 16 of 35 Evidence: devised detailing information reported to the district nurse and any advice given. This included that date of the advice, the condition reported and any outcome/advice given. There was also a pressure area prevention equipment monthly check list, which is good practice. One further risk assessment was completed in one of the care plans examined and this was in relation to smoking. This was detailed and related specifically to the person concerned. However, there were no risk assessments in place regarding the management of challenging behaviour and the risk of this to the person concerned, other residents and members of the staff team. It was positive to note that residents were weighed on a monthly basis. One care plan contained clear records of visiting health care professionals such as district nurse visits, GP visits, social worker visits, and input from the community psychiatric nurse. Care and support plans regarding specific health care needs did not contain enough detail i.e. one resident was considered to be at risk of falls because of Parkinsons Disease, however, there was no other reference as to how to support the resident in relation to this or how to recognise a change in symptoms within the care plan. In discussion the administrative manager stated that the person does not have Parkinsons Disease, however the care plan did not reflect this. During the course of the inspection resident and staff interaction was observed. The residents were treated respectfully and with familiarity. Staff members were over heard speaking with residents in a friendly way and ensuring their dignity in supporting with personal care. One person spoken with stated that the residents at the home do receive good care and that the staff are aware of the needs of the residents. The medication process was looked at. It was positive to note that there were no omissions on the medication administration records that were examined and that the controlled drugs register was maintained in line with regulation. The drugs examined tallied in number with the number recorded in the register. A pharmacy audit report was examined and this contained positive information about the procedure at the home Good working relationship between home and (pharmacy). Residents/clients treated as individuals and medication schedules modified to reflect individual needs i.e.early night residents taking night time meds at tea time rather then awake them later. All of the medication procedures and processes were audited by the pharmacist as being undertaken appropriately. The administrative manager confirmed that only the senior staff within the home administer medication and that there is in-house training whereby the staff read the Care Homes for Older People Page 17 of 35 Evidence: policies and procedures, observe people administering medication and then are supervised administering medication themselves. The staff also undertake a distance learning certificate course in medication. According to the training matrix completed by the home 8 members of staff had undertaken medication training, and there was a clear distinction between whether this was Boots training, internal training or advanced training. 2 of these were also enrolled to start the advanced training, 2 people were in the process of doing this. One care worker spoken with who was working up to the position of senior care stated that they had completed medication training, observed the administration of medication and did apply creams and sign that they had done so. Care Homes for Older People Page 18 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Wellington House are given adequate opportunity to take part in a variety of activities and to maintain family relationships. The food in the home is of a good quality, offers a choice and meets the dietary needs of the residents. Evidence: On the occasion of both visits to Wellington House the majority of residents were situated in the communal lounge. It was positive to note that a relative was visiting one resident and one person was knitting. Some residents were dozing in their armchairs. One resident was observed spending time in his room and another was upstairs in his room. There is no specific activities co coordinator employed at the home. One person spoken with stated that the staff team are encouraged to participate in activities with residents. They stated that these included going into town for a cup of tea and a sticky bun, manicures, opting to do nothing, watching films, hand and arm massage, reminiscence. The home also has themed weeks. For example Out of Africa into Sri Lanka, where a Care Homes for Older People Page 19 of 35 Evidence: film show of photos with music is shown to the residents and they look for particular animals. The home is dressed with camoflage netting and photos of animals with information included. There were photographs on the wall in the hallway of the staff team dressed up for Halloween and a photo of the PAT dog. The activities file was examined where the activity of the day was listed for each person, however, this did not contain much detail. On 12/11/08 it stated skittles;14/11/08 Bingo; 17/11/08 Pottery; 18/11/08 Bingo; 21/11/08 Hedgehog balls. In one residents care plan it identified that he enjoyed bell ringing, however there was no evidence in place to suggest that he had been able to access this or something similar. It is important that the activities provided at the home are meaningful and stimulating to the individual as far as possible. 2 of the resident surveys stated that there are always activities arranged by the home and 2 stated that there sometimes were. The quality assurance completed by the home 3 people said that the activities were good and 3 said that they were not. It was positive to note that the residents were offered pottery classes on a monthly basis and that a pantomime had been booked for Christmas. It was also positive to note that one member of staff spoken with brought in specific items as reminiscence aids for the residents. On the day of the site visit she had cut out some photographs from the local paper of pubs that had closed down over a long period of time in the area where one of the residents lived. She said that she had brought it in to show him, to prompt discussion. The administrative manager stated that one of the residents had been supplied with a greenhouse as they had been a farmer and enjoyed growing plants and vegetables. One member of staff spoken with said that the home has an open door policy for family. They said that the family can come in for meals if they want to and that there was always usually at least one relative at the home. The kitchen was visited during the partial tour of the premises and this was clean, tidy and well organised. The second chef was spoken with and demonstrated clear knowledge of the residents and their dietary needs. She stated that all of the food is home cooked and that there is a daily choice of meals for the residents along with a choice of hot or cold puddings. Mid afternoon snacks are offered and the evening meal Care Homes for Older People Page 20 of 35 Evidence: consists of soup or sandwiches. There were a choice of home made cakes available. The second chef stated that they had completed advanced food hygiene training and some in house infection control training. Safer food better business was observed to be in use within the kitchen and records were seen of daily recorded fridge and other relevant temperatures being taken. The daily, weekly and monthly cleaning task lists were ticked as completed. All 4 of the resident surveys completed stated that they always liked the meals at the home. One person wrote Very good. Care Homes for Older People Page 21 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Wellington House has a clear complaints procedure, however not all of the residents are clear about how to make a complaint. Safeguarding training has not been satisfactorily completed by all of the staff team at the home. Evidence: There have been no complaints received about the service provided at Wellington House since it was registered as a new service. The complaints log was examined and this demonstrated that complaints would be recorded along with the course of action taken. The complaints procedure is contained within the homes brochure and is on display at various places within the home. 3 of the residents who completed surveys stated that they always knew who to speak with if they were unhappy, 1 person said that they usually did. 3 people stated that they know how to make a complaint and 1 person stated that they do no know how to make a complaint. There has been one safeguarding referral at the home. This has been managed appropriately. The Commission have been informed by receipt of a Regulation 37 and further updated information from the manager. A number of compliments have been received at the home. For example, one card received stated, Please accept this bird bath to enjoy in your garden......on behalf of mum......who you looked after with love and kindness, a second stated Many thanks Care Homes for Older People Page 22 of 35 Evidence: for all you did for mum and a third card said, I would like to thank you all on behalf of the family for your support. According to the training matrix completed by the home nine members of staff have completed training in the safeguarding of vulnerable adults, five staff members are currently undertaking the training and six are booked onto the training. Two members of staff spoken with were aware of who to report a suspected incidence of abuse to. Fourteen members of staff have completed manual handling training and there was no information recorded for four members of care staff. It was positive to note that one member of the staff team had completed instructor training in this area. These are areas of core training that all members of the staff team should undertake on an ongoing basis to ensure that the residents who live at the home are safeguarded. It was however positive to note that all except 2 of the care staff have either completed or are enrolled to undertake NVQ training at either level 2 or 3. Care Homes for Older People Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Wellington House provides a pleasant, homely environment which is clean and tidy. Evidence: Wellington House is a detached listed building. A partial tour of the premises was undertaken. It was positive to note that the living area was comfortable and homely. The dining area was nicely laid for lunch. All of the bedrooms looked at were neat and tidy and had objects and photographs that were personal to the residents. The home is housed in a listed building and the internal environment does have long corridors and slopes in the floors. There are grab rails along the corridors to support people when walking. One bedroom door was observed to have signage in the form of the residents name and an image. In discussion a member of staff stated that only those people with dementia had signs on their doors and that there were other examples within the home. The bathrooms and toilets did not have visual images, but did have written signs. There was a stair-lift in place on one of the sets of stairs at the home to make access Care Homes for Older People Page 24 of 35 Evidence: to the upper floor easier and possible for some of the residents. There was major building work taking place to the rear of the home, in the form of a two storey extension. The building work was on the days of the site visits to the home, unobtrusive. The home was clean and tidy and there were no odours detected during the site visit. 3 of the resident surveys received by the Commission stated that the home was always clean and tidy and 1 person stated that it usually was. According to the training matrix 11 members of that staff team had completed Essential Steps infection control training during October and November of this year. It was positive to note that both of the chefs had completed this training, however, the domestic at the home had not completed it and was not in the process of doing it. 6 further members of staff were in the process of doing this training. Care Homes for Older People Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager at Wellington House recognises the benefits of NVQ training within the home and this is reflected in the amount of staff who have received this training. Recruitment at the home is robust and safeguards the people who live there. Core training is satisfactory, however there are some gaps. Evidence: On the first visit to the service, the administrative manager stated that the staffing complement at the home is 1 senior care worker and 3 care workers in the morning, 1 senior care worker and 2 carers in the afternoon and 1 senior and 1 care worker at night. The rotas were examined in relation to this. The total staff required for carers was recorded as 3 for both morning and afternoon shifts. The total staff actual column of the rota was not completed and neither was the total hours worked by staff column. The rota for the week commencing 01/11/08 stated that two carers were on duty in the morning , one of these on a long shift from 8am until 9pm. It was unclear whether there was a second person on duty in the afternoon. Overall the rotas examined were difficult to interpret and it was not always possible to gain a clear picture of which staff were working when. However, it was the case that at both of the visits to the home there was a senior member of staff on duty and a number of care staff. The manager of the home was on the rota as a senior to cover some of the shifts each week. Care Homes for Older People Page 26 of 35 Evidence: The administrative manager stated that the home currently has one vacancy for a night carer, however this is in the process of being filled and that the home have been using some agency staff. On the first visit to the home there was no evidence of records detailing specified recruitment information being kept regarding agency staff, however, by the end of the visit this information had been gathered and filed. 3 of the resident surveys completed stated that staff are always available when you need them, and 1 stated that they usually are. In line with these, all 4 residents stated that the staff listen and act on what they say, however one comment stated that this was usually the case. There are two chefs employed at the home and one domestic. The rotas also detail a third catering person who worked 2 hours per week at the home, but this person was not recorded on the training matrix. As previously mentioned NVQ training at the home has been completed or is being undertaken by the majority of the staff team. 5 members of staff have completed NVQ2, 4 have completed NVQ3, 2 have completed both NVQ2 and NVQ3. 1 senior carer is a registered nurse, 1 has an NVQ equivalent qualification and 3 staff were enrolled to do NVQ2 and 1 NVQ3. 2 of the care team do not have and are not enrolled to complete the training and neither is the domestic. Two staff recruitment files were examined and these contained all of the specified information required to make sure that the residents are safe and protected from harm. For example, there was evidence of criminal records bureau checks being completed prior to people starting work at the home and POVAFirst checks were also undertaken. Application forms examined were completed and there were no gaps in the employment history of the applicant. References were in place as was proof of identity and proof of address. There were no photos of the applicants on the files, however, these were maintained on the homes computer and had been attached to the files by the second site visit. The training matrix completed by the home demonstrated that training is in progress, however there were some gaps. For example Wellington House is registered for 21 people in the specific categories of old age and dementia. Only 2 of the staff team had a date on the training matrix suggesting that they had completed training in this area. 4 further staff were doing training through Otley College. The matrix does state that all of the staff are booked and in discussion the manager said that as of January 2009 the Alzheimers Society training Yesterday, Today and Tomorrow will be on-going for all of the staff team. Care Homes for Older People Page 27 of 35 Evidence: The training file for one newly appointed carer was examined and this showed that core training was taking place as they had completed protection of vulnerable adults training 27/10/08; fire safety 22/10/08; safe food handling 22/10/08, health and safety 22/10/08; manual handling 21/10/08 and care planning 20/10/08. They had also completed practical skills 24/10/08; communication skills 27/10/08; role of the worker 20/10/08 and principles of care 20/10/08. Induction was recored as having been undertaken by 3 of the staff team, however, the administrative manager stated that all of the staff group are going through induction with Healthcare Homes. Care Homes for Older People Page 28 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the required qualifications and experience and is competent to run the home. Evidence: The manager at Wellington House is registered with the Commission. She has completed the Registered Managers Award, NVQ4 in management and is a trainer/assessor for the NVQ in both care and management. The administrative manager at the home was registered with the Commission until two years ago. It was clear from the site visits to this service that both managers work closely together to run the home. Although this can be an effective system it must be clear that the person registered with the Commission is at all times responsible for the management of the service. During the inspection the manager was observed working with two members of staff and a resident, and it was clear that she has a good understanding and knowledge of Care Homes for Older People Page 29 of 35 Evidence: the residents and their needs. Two members of staff spoken with stated that the manager was open and supportive. All of the staff surveys received stated that the manager met with them on a regular basis to give support and discuss how they were working. One comment received stated, Manager/staff has good relationship and regularly talk about all aspects of work/training/relationships etc. Manager is always happy to help, a second member of staff stated, We have appraisals every two months. But if I ever need to talk to my manager she is always approachable. If she is not at work she tells me I can always ring her at home. Healthcare Homes had undertaken an annual quality assurance report of Wellington House. 19 resident/relative surveys were distributed and 7 of these were returned, 14 external stakeholder questionnaires were distributed and 7 of these returned and 23 staff questionnaires were sent out and 5 of these were returned. The information received as a result of the questionnaires has been compiled into a report, and the data has been analysed. It was positive to note that 5 of the stakeholders said they would recommend Wellington House as did all 7 the resident/relatives surveys. Only 20 of the staff surveys i.e. 1 person felt they knew what the home was trying to achieve and how they contributed. 3 of the residents/relatives found the activities programme stimulating with a range of activities and 3 did not, one person did not answer this question. By the next key inspection it will be possible to determine whether this information has been used to devise a development plan for improvement in the areas highlighted. During discussion the administrative manager stated that Wellington House does not handle any of the residents financial affairs and that one resident is able to look after their own finances. A staff supervision summary was examined and this provided details of an ongoing system of staff supervision. In the main part this was carried out on a monthly or two monthly basis. For example one member of staff had, according to the matrix, received supervision on 29/07/08 and 23/09/08, another member of staff had been supervised 04/06/08, 08/08/09 and 06/10/08. Supervision reflects a good practice approach to supporting the staff team. A number of records were examined in relation the health and safety. The stair-lift at the home was serviced 02/02/08, there were records to demonstrate that fire alarm tests were carried out weekly, fire extinguishers and emergency lighting on a monthly basis. There was evidence of fire drills being carried out. The water temperature at the home was recorded monthly until July 2008 from when there were no further records. Care Homes for Older People Page 30 of 35 Evidence: 6 members of staff had completed health and safety training in October and November 2008 and 4 had done the training in 2005. 11 staff have therefore not completed the training. It is important that all training relating to health and safety is completed on an on-going basis, this also includes core training such as moving and handling and POVA. It was positive to see that all of the staff team were booked on fire matters training and that 13 of the staff team had completed this. Care Homes for Older People Page 31 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must prepare a written plan detailing how the individual residents needs are to be met in respect of their health and welfare. A comprehensive care plan must be compiled with each individual resident detailing the actions the staff team must take to meet all of their personal, health and social care needs. 30/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The assessment of potential residents would benefit from being completed in more detail, so that this along with any Care Management assessment can form the basis of a comprehensive plan of care for daily living for each individual resident. The home would benefit from ensuring that the all of residents individual preferences and expectations are identified and satisfied regarding their social, cultural, 2 12 Care Homes for Older People Page 33 of 35 religious and recreational interests and needs. 3 16 It would benefit the residents if all of the people who live at the home and their relatives are clear about how to make a complaint. This is in relation to one resident stating they were not sure how to complain if they were unhappy. The manager of the home must make sure that all of those members of staff who have not yet completed safeguarding training, but are booked onto a course, complete their training to ensure that the residents are protected from possible harm or abuse. It would benefit the home if all of the staff team undertake specialist training in areas such as dementia and challenging behaviour, as the home is registered for both older people and those with dementia. Ensure that all records pertaining to health and safety are maintained and kept up to date and that all training relating to matters of health and safety is completed by all of the staff team. 4 18 5 30 6 38 Care Homes for Older People Page 34 of 35 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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