Inspection on 28/02/06 for Wellington House

This inspection was carried out on 28th February 2006.

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

Wellington House 02/11/06

Wellington House 12/11/04

Wellington House 20/05/04

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

CARE HOMES FOR OLDER PEOPLE Wellington House Longforth Road Wellington Somerset TA21 8RH Lead Inspector Jane Poole Announced Inspection 28th February 2006 09:30 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 Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 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. Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Wellington House Address Longforth Road Wellington Somerset TA21 8RH 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) 01823 663667 01823 665917 Wellington Care (Somerset) Ltd Mrs Elizabeth Anne Thorne Mrs Margaret Milton Care Home 33 Category(ies) of Dementia - over 65 years of age (33) registration, with number of places Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Room 18 should only be used for service users who are mobile and able to use the nearby facilities. Up to 5 beds, can be used for people over the age of 65 with mental health needs (not dementia) One named person under 65 years of age Date of last inspection 21st July 2005 Brief Description of the Service: Wellington House is set in the centre of Wellington within walking distance of all local amenities.The home is owned by Wellington Care Limited and is registered to provide personal care to up to 33 people over the age of 65 who have a dementia or other mental health difficulties. The registered manager position is shared by Maggie Milton and Elizabeth Thorne. Wellington House is part of a three-way partnership with Somerset Social Services and the Somerset Partnership NHS and Social Care Trust through the special rate scheme. There is a liaison nurse who visits the home regularly to give advice and support. The house itself is a well presented home. Accommodation set on three floors with a passenger lift between. All bedrooms are for single occupancy. With the exception of two, all rooms have en suite facilities. Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over a 7 hour period by Jane Poole and Alison Philpot. There were 24 people living at the home at the time of this inspection. The inspectors were given unrestricted access to all areas of the home, were able to speak with staff and service users and to observe care practices. 16 visitors/relatives, 3 professionals and 22 service users completed comment cards prior to the inspection. What the service does well: What has improved since the last inspection? Since the last inspection the home has improved the way it offers choices to service users at meal times. The inspectors observed staff showing meals at the dining table to enable people to make a choice at the time of the meal. Some areas of the home have been redecorated and bathrooms have been made more homely with plants and pictures. Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 6 The home have introduced satisfaction questionnaires to people visiting the home and these gave evidence that visitors are given opportunities to view the home and speak with staff before deciding whether or not to use the facilities on offer. 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. Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 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 Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5. Service users are able to see visitors at any time, in communal areas and in private. All prospective service users are fully assessed by the home and appropriate professionals to ensure that their needs can be met. EVIDENCE: Since the last inspection the service user guide has been updated to reflect all changes that have occurred in the house and to ensure the information given is up to date. The statement of purpose continues to be reflective of the services offered by the home. All rooms at the home are block contracted by Somerset Social Services and Somerset NHS and Social Care Trust. A member of the community mental health team assesses all prospective service users. A senior member of the homes staff also meets and assesses any prospective service user to ensure Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 9 that they will be able to meet their needs and also to determine their compatibility with people already living at the home. The inspector saw copies of service user contracts that had been signed by the home and the service users or their representative. Service users and their representatives are able to visit the home before making a decision to move in. The home has started asking visitors to the home to complete satisfaction questionnaires and a sample of these were viewed by the inspector. They gave evidence that people were made welcome and given appropriate information about the services and facilities. Service users living at the home are able to have visitors at all reasonable times and are able to see their friends or relatives in private if they wish to. Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 & 10. Care plans would benefit from having more information about service users individual behaviour. Service users have access to appropriate healthcare services. EVIDENCE: All service users have a pre admission assessment from which individual care plans are created. The home uses the SHARP system of care planning, which covers all areas of physical care and has some areas of mental health and psychological need. The inspector looked at three care plans in detail, it was noted that some areas of individual behaviour were not covered. For example one service user regularly goes into other people’s rooms and removes personal items, there is no mention of this behaviour in the care plan. In another care plan the home had put in place an ABC (antecedent, behaviour, consequence) chart, this had not been filled in correctly. All service users are registered with local GP’s and other healthcare professionals in line with their individual needs. All medical appointments are Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 11 recorded in the care plan. Discussion with the managers gave evidence that the home have developed good links with local professionals. A specialist liaison nurse visits the home on a regular basis to offer guidance and support on mental health issues. Re-assessments of need are carried out by appropriate professionals when the home feel they are no longer to meet a service users needs. The home uses the Boots Monitored Dosage system for all medication. There is adequate storage for medication including controlled drugs and those that require refrigeration. The inspectors viewed the Medication Administration Records and found them to be well maintained. Some gaps in the signing were noted and these were discussed with the managers at the time of the inspection. Controlled drugs were sampled and records correlated with stocks held. All service users have single rooms where they are able to spend time in private if they wish to. The inspectors observed that staff interacted with service users in a respectful and friendly manner. All requests for assistance were handled in a sensitive manner. All personal care is carried out in private. Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 12, 13, 14 & 15. There are high levels of social stimulation in the home with dedicated workers, care staff and outside professionals providing a variety of entertainment and activities. Visitors are made welcome at the home. EVIDENCE: The inspectors observed that throughout the day there was interaction between staff and service users. Some activities were arranged on a group basis and for those that did not wish to join in staff spent time with them on a one to one basis. The home employs two activity workers and there is a weekly activity programme, which is displayed in the home. In addition to the activities workers the home also has regular outside entertainers, a visiting artist, a music therapist and representatives from the church visiting the home. It was apparent on the day of the inspection that care staff see social stimulation as a major part of their role. The home operates a 4 week menu and all meals are cooked on the premises using local produce and suppliers where available. The inspectors observed the main meal of the day being served, it appeared appetising and nutritious, Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 13 portions seen appeared ample. A requirement of the last inspection was for the home to ensure that people were given a choice of meal. Due to the shortterm memory difficulties that many people are experiencing it would not be practical for many of the service users to make a choice in advance of the meal. At this inspection staff were showing service users both meals and allowing them to make choices at the dinner table. 16 people completed relative/visitor comment cards prior to the inspection all answered YES to the question; “Do staff/owners welcome you in the home at any time?” Comments included “staff are always welcoming whenever you turn up and always ready to listen to any concerns” and “the friendliness and cheerfulness of staff makes visiting much easier.” All answered YES to the question “Are you able to see your friend or relative in private. Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 16 & 18. Appropriate steps have been taken to minimise the risk of abuse to service users. Some bedrooms doors were locked on the day of inspection and there was no mention of this restriction in care plans. EVIDENCE: There are policies in respect of making a complaint, recognising and reporting abuse and whistle blowing. The complaints procedure is contained in the service user guide and is on display in the main entrance hall. The home has a copy of the Somerset ‘Safeguarding Vulnerable Adults’ policy and staff have received training in recognising and reporting abuse. All staff are checked against the Protection Of Vulnerable Adults register before commencing work and undergo an enhanced Criminal Records Bureau check. There are electronic keypads on the entrances to the home, which restrict the movement of service users, but all service users are assessed as requiring this level of security. At the time of this inspection some bedroom doors on the ground floor were locked due to the behaviour of one service user. Obviously this meant that the service users were unable to easily access their private rooms. This practice had not been documented in care plans. Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26. Wellington House provides a comfortable, well-maintained environment for service users. A team of ancillary staff ensure that the cleanliness of the home is maintained to a high standard. EVIDENCE: The home is set in the centre of the town of Wellington, it is within walking distance of the town centre and all other local amenities. Service user accommodation is set over three floors and there is a passenger lift between. The home specialises in the care of people who have a dementia and is locked by an electronic keypad. There are secure landscaped garden areas to the front and side of the home and all service users have unrestricted access to these. Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 16 All rooms are for single occupancy, all are clearly marked with names and pictures to enable service users to orientate themselves and therefore promote independence. A sample of bedrooms were viewed all had been personalised to reflect the tastes and needs of the individual service users. All communal areas are located on the ground floor. There are two large lounge/diners and a conservatory. Service users have unrestricted access to all communal areas. All areas seen were well maintained and comfortably furnished. Since the last inspection, one of the communal lounges has been redecorated. A new shower room is being installed and an additional storage area has been created. Bathrooms have been made more homely with plants and pictures. There is a large laundry on the ground floor and this was seen to be well organised and clean. There is a team of domestic staff who are responsible for the cleanliness of the home. On the day of the inspection, as with every other visit to the home, all areas were clean and fresh. Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30. The home is adequately staffed to meet the needs of the service users. EVIDENCE: The home employs 23 care staff and 12 ancillary staff. 13 members of the care staff team have a National Vocational Qualification in care at level two or above. Duty rotas sent to the inspector prior to this inspection show that there is usually 4 staff on duty during the day. At times this falls to three and at other times rises to 5. The managers’ hours are in addition to this and are not included in these figures. Overnight there are three waking night staff. In addition to the care staff there are activity workers, kitchen staff, domestic staff, laundry assistants and a maintenance person. The inspectors viewed the recruitment files of the four most recently appointed members of staff. All staff had been checked against the Protection Of Vulnerable Adults registered and all had undergone enhanced Criminal Records Bureau checks. One of the files viewed only contained one written reference, not two as required under schedule 2 Care Homes Regulations 2001. All staff observed during the inspection appeared competent and well motivated. Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 18 All 16 relative/visitors who completed comment cards prior to the inspection answered YES to the question “In your opinion are there always sufficient numbers of staff on duty?” One person commented that “the staff are courteous and well motivated in the role they perform.” Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 36, 37 & 38. The home is well managed taking account of the views of service users and their representatives. Appropriate steps have been taken to ensure the health, safety and welfare of service users. EVIDENCE: The registered manager position is shared by Margaret Milton and Elizabeth Thorne. All responsibilities are shared and both continue to work alongside care staff to offer ongoing support and guidance. Between them they have many years experience of working with older people and older people with mental health difficulties. Both managers have completed National Vocational Qualifications (NVQ) at level 4. Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 20 There is clear management structure in the home with identified lines of accountability and responsibility. There is a senior carer on duty on each shift who offers support to less experienced members of staff. All staff receive regular formal supervision in addition to ongoing informal supervision. A regular newsletter is complied for staff to ensure that everyone is kept up to date with happenings in the home. There is also a regular newsletter for service users and their representatives. All staff and service users spoken to felt that the management in the home were open and approachable. Reasonable steps have been taken to ensure the health and safety of service users. A full time maintenance person is employed who carries out regular checks on the building and equipment. Excellent records are kept of these checks. Fire alarms are tested weekly in house and emergency lighting is tested monthly. The system is regularly serviced by outside contractors. Staff receive regular training in fire safety and take part in random fire drills. At the time of the inspection no records were available of the staff members who had taken part in fire drills and it is recommended that a list be kept. All equipment in the home is regularly serviced and checked. This includes wheelchairs, water temperatures, electrical appliances and call bells. All accidents in the home are recorded and the managers audit these records on a regular basis. A sample of policies and procedures were viewed by the inspector and found to be appropriate to the home. There was evidence that policies and procedures are kept up to date by regular review. Certificates of registration and insurance were up to date and displayed in the entrance hall. Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 21 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X 3 3 3 Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 22 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 OP9 Regulation 13(2) Requirement The managers must regularly audit the Medication Administration Records to ensure that they are correctly signed when administered or refused. The managers must ensure that service users have unrestricted access to their personal rooms unless stated in the agreed care plan. The managers must ensure that all recruitment files contain two written references. Timescale for action 31/03/06 2 OP16 12 (4)[a] 31/03/06 3 OP29 19(1)[b] 31/03/06 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 Refer to Standard OP7 OP38 Good Practice Recommendations The managers should ensure that care plans fully reflect the needs and behaviours of service users. Records should be kept of all staff taking part in fire drills. Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Wellington House DS0000028255.V280600.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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