Inspection on 12/06/06 for Wellington Park Nursing Home

This inspection was carried out on 12th June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Wellington Park Nursing Home 10/10/07

Wellington Park Nursing Home 12/12/05

Wellington Park Nursing Home 19/05/05

Wellington Park Nursing Home 10/01/05

Wellington Park Nursing Home 19/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Wellington Park Nursing Home 76 Wellington Road Bush Hill Park Enfield Middlesex EN1 2PL Lead Inspector Peter Illes Key Unannounced Inspection 12th June 2006 09:45 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 Park Nursing Home DS0000027825.V295918.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. Wellington Park Nursing Home DS0000027825.V295918.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wellington Park Nursing Home Address 76 Wellington Road Bush Hill Park Enfield Middlesex EN1 2PL 020 8360 5977 020 8364 0696 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) www.bupa.co.uk BUPA Care Homes (GL) Ltd Jane Ann Hepton Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Wellington Park Nursing Home DS0000027825.V295918.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 30 service users may receive nursing care. Date of last inspection 12th December 2005 Brief Description of the Service: Wellington Park Nursing Home is owned by BUPA Care Services providing both nursing care and personal care. The home is registered for thirty-three older people of which thirty places are for service users who require nursing care. The home is purpose built and is situated in a residential area, approximately one mile from Enfield Town. All bedrooms have en-suite facilities, telephone point and a remote controlled television. One room is currently shared by two service users with the rest of the rooms being single occupancy. The inspector was informed that the use of double rooms was gradually being reduced. Respite care is provided for people who normally live at home. The registered manager stated that the current cost of a long stay place in the home is between £500 and £1000 per week depending on the service user’s assessed needs and the type of room occupied. The cost of respite care is between £125 and £150 per day. Information about the service is made available to all prospective service users and a copy of the latest CSCI report is kept in reception at the home and the contents fed back to staff when it is received. The home’s stated aim is to provide high quality nursing care for the older people who live there using the company’s health and care knowledge, specialist skills and values to deliver as individual a service as possible to residents. Wellington Park Nursing Home DS0000027825.V295918.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took approximately nine and a half hours with the registered manager being present or available throughout. There were twenty two service users accommodated at the time of the inspection with one being in hospital at the time. The home had number of vacancies and is in the process of reviewing the use of its double bedrooms. This will have implications for the maximum number of people it may accommodate in the future. The inspection consisted of: meeting and speaking to the majority of service users, six of them independently; discussion with four relatives that visited, three of them independently; a brief discussion with a visitor from a local church; discussion with the head of care; independent discussion with two other nurses; discussion with a visiting G.P.; independent discussion with three care staff and discussion with the administrator and handyperson. Further information was gained from a tour of the home and a range of documentation kept at the home. What the service does well: What has improved since the last inspection? There were seven areas identified for improvement at the last inspection, four of these had been achieved leaving three others that are restated in this report. The improvements that have been made are in the following areas: an identified improvement regarding administration of medication; strengthening the home’s adult protection procedures; providing a lockable space for an Wellington Park Nursing Home DS0000027825.V295918.R01.S.doc Version 5.2 Page 6 identified service user in their bedroom to keep their possessions in and addressing an identified equalities issue. 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 Park Nursing Home DS0000027825.V295918.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 Wellington Park Nursing Home DS0000027825.V295918.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective and existing service users needs are assessed by the home to assist staff meet these needs when they are first admitted. Their needs continue to be monitored once admitted to the home to ensure that their changing needs can also be effectively addressed. The home must take appropriate action to ensure that service users accommodated fall within its category and conditions of registration. EVIDENCE: Five new service users had been admitted to the home since the last inspection. Files for four of these service users were inspected at random and each showed a range of satisfactory assessment information that was available to the home at the point of admission. The assessment information included information from statutory agencies that had made referrals. Evidence was seen of hospital discharge assessments including a functional assessment from a physiotherapist for one service user. All four files also contained evidence of an in-house assessment, including an assessment of nursing needs, which was Wellington Park Nursing Home DS0000027825.V295918.R01.S.doc Version 5.2 Page 9 undertaken prior to the service user being admitted to the home. The fifth service user had been admitted to the home before the last inspection but assessment information at the point of their admission was also available on their file. There was also evidence that key assessment information for all fiveservice users was reviewed on a monthly basis. The areas subject to monthly review included health indicators such as body temperature, pulse, respiration and blood pressure, skin condition and vulnerability as well as moving and handling. It was noted during the inspection that three service users appeared to be demonstrating symptoms of dementia in their daily functioning. There was evidence that this had been recognised by the home and that these three service users had been referred for further formal assessment from an external healthcare professional. A stated reason for this was to determine if the dementia was now the main need for nursing/ personal care. A G.P. was called to the home during the inspection to see one of the three service users because of a chest infection. Staff were having difficulty managing that service user’s behaviour at the time and consulted the G.P. about this as well. The inspector also spoke to the G.P. He was clear that the home was meeting the service user’s needs as well as they could and indicated that to move the service user may not be in their best interests. A church visitor who visited this service user was also spoken to independently. The church visitor was also concerned about the recent change in the service user’s behaviour but was complimentary about the staff and the care at the home. If the external healthcare assessment does indicate that dementia is now the main need for care for any of these service users further action is needed by the home. A requirement is therefore made that if dementia is now assessed as the main reason for the person being accommodated, the home must then apply to the Commission for a variation to its conditions of registration for each of these service users if it wishes to continue to care for them. The home does not provide intermediate care. Wellington Park Nursing Home DS0000027825.V295918.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Effective systems are in place to record service users needs on their care plans although the plan for one service user needs to be updated to reflect their rapidly changing needs. Service users are well supported regarding their health care needs although recording of routine health appointments needs to be improved to further promote regular access to these services. Satisfactory medication policies and procedures are in place to safeguard service users. However, further care is needed in their implementation for identified service users and further attention is needed to ensure that medication is stored appropriately. Service users are treated with respect and dignity by staff at the home although service users would further benefit from improvements to identified toileting facilities to aid this. EVIDENCE: Five service users care plans were inspected. These care plans were generally up to date and of good quality. Individual sections of the plans included identified needs that were generated from assessment information and provided clear guidance to staff on how to address these needs. The individual Wellington Park Nursing Home DS0000027825.V295918.R01.S.doc Version 5.2 Page 11 plans included standard sections on nursing needs and intervention, personal hygiene, safe environment, physical mobility and a separate night care plan. Other sections of the plans related to individual needs arising from specific assessed needs. These included action needed as appropriate for individual service users in relation to protecting vulnerable skin, monitoring diabetes and preventing the spread of MRSA. Evidence was seen that care plans were reviewed and evaluated on a monthly basis and were informed by current risk assessments. Evidence was also seen that the home obtained consent to take service users photographs for their files, obtained consent to use bed rails and that one service user had a recent risk assessment in relation to the use of an electric wheelchair. Evidence was also seen on some care plans to indicate that the plans had been explained to the service users. One service user, referred to in the Choice of Home section of this report, whose behaviour was challenging staff during the inspection, had a care plan that had been reviewed in the previous month. However this had not been updated since to reflect the current situation or give staff clear guidance on how to address this behaviour. A requirement is made regarding this. The majority of service users are registered with one of two G.P. practices with evidence seen, including on service user’s files, that G.P.’s visit the home on a regular basis. Evidence was seen to indicate that service users had access to other health resources such as dentists, opticians and chiropody and some service users spoken to confirmed this. However, this evidence was not easily retrievable from the files and, in the inspector’s view, it was not easy for staff to monitor on a regular basis when routine checks were due. A requirement is made that the home keeps a separate record of appointments with healthcare professionals on each service user’s file to assist monitor their ongoing healthcare needs. Medication and medication administration record (MAR) sheets were inspected for three service users. The inspector was pleased to see that a requirement made at the last inspection for the home to ensure that MAR sheets were signed at the time medication was administered was being complied with. One type of medication prescribed for one service user was seen to be in two separate boxes. Both of these boxes had been used to administer medication and were half full. Another type of medication for the same service user was in a box supplied by the pharmacist but was not the original box supplied for the current medication as the date written on it was October 2005. The medication is supplied to the home each month. A requirement is made that prescribed medication for service users must be kept in and dispensed from its original packaging to avoid the danger of mishandling unless otherwise directed by a person competent to make that decision. However, evidence seen on the MAR sheet for that service user indicated that their medication was being administered correctly. At the last inspection a requirement was made that the temperature of the area where medication is stored is maintained at 25oC or below. The weather at the time of the inspection was exceptionally hot and a Wellington Park Nursing Home DS0000027825.V295918.R01.S.doc Version 5.2 Page 12 fan in the medication storage area did not seem to be functioning correctly. The temperature on the thermometer kept to monitor the temperature in the medication storage area showed 30ºC when inspected. In addition, the temperature recorded on the daily record for the previous three days showed temperatures of between 26ºC and 28ºC. The requirement is restated. The inspector was pleased to see that a good practice recommendation made at the last inspection that the home should consider purchasing a larger dedicated refrigerator for storing medication had been complied with. Service users were seen to be treated with respect and dignity by staff during the inspection. This was confirmed by a number of service users and relatives spoken to independently. One service user who had been admitted to the home since the last inspection told the inspector that they had been asked what name they preferred to be called by when they were first admitted. A relative of another service user told the inspector that they visited the home four or five times a week and staff always made them welcome and made them a cup of tea. During the inspection staff were seen to assist service users with their lunch in a relaxed and sensitive manner. Staff spoken to were able to describe some of the individual preferences of service users regarding their personal care and general routines of daily life. The inspector was informed during the inspection that two adjoining toilets on the lower floor of the home were very cramped when service users who used wheelchairs needed to be assisted to use the toilet. These are the only toilets on that floor, are adjacent to the home’s dining room and main lounge and are in heavy demand. The inspector was informed that on occasions it was not possible to assist a service user in a wheelchair to use the toilet without leaving the door open which compromised their privacy. A separate requirement and recommendation are made regarding this in the Environment section of this report. Wellington Park Nursing Home DS0000027825.V295918.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 at least once during a 12 month period. 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. Service users benefit from a range of social and recreational activities both in and outside of the home, which meet their needs and preferences. Families and visitors are made welcome at the home, which they and service users appreciate. Service users are encouraged to exercise as much choice and control over their lives as they can to maximise their independence. Service users also enjoy a range of good quality meals that they enjoy. EVIDENCE: Service users have access to an activities programme that was seen to include a range of appropriate activities in the home. An identified member of staff at the home has allocated responsibility for organising and monitoring these. This included weekly quizzes, appropriate keep fit exercises, bingo, discussions and hand massage. Service users spoken to confirmed that these took place and that they were enjoyable. The home organises three to four social events for service users, relatives and others during the year. The home was in the process of planning its next event, an afternoon tea with live entertainment for a Saturday at the beginning of July 2006. The home also runs one off events when appropriate and the inspector was given an advert for a local clothing supplier who it was planned would visit the home during July 2006 to display Wellington Park Nursing Home DS0000027825.V295918.R01.S.doc Version 5.2 Page 14 and sell a range of clothing if service users were interested in this. The home has access to some transport and undertakes outings to a local social club for those service users that wish to participate. A programme of these activities was given to the inspector. One service user who was spoken to independently stated that they really enjoyed these visits. The home has a stated policy of welcoming relatives and friends to visit the home. Several relatives were spoken to independently during the inspection and gave positive feedback about the welcome they received and about the attitude of staff towards them and the service users. One relative spoken to stated that if they had a query or problem they could raise it with the staff on duty and it would be dealt with appropriately. A regular visitor from a local church was also spoken to independently and they also gave positive feedback regarding the home and its staff. Service users bedrooms that were inspected were seen to have been personalised to vary degrees including with photographs and other personal possessions. The home’s registered manager and an administrator confirmed that service users, their relatives or other representatives deal with all the service users finances and that the home did not keep money or deal with finances for any of them. The home’s chef manager was spoken to independently and the inspector found her competent and knowledgeable, including about the individual dietary needs and preferences of the service users. The home has a four week menu that was seen to have a choice of courses for lunch and supper, some appropriate options were available to meet the preferences of service users from a range of different ethnic backgrounds. The chef manager stated that if a service user did not want the choices on offer an alternative such as a salad could be prepared. The inspector was told the home was currently providing meals for vegetarians, service users with diabetes and a number of meals that needed to be pureed for individual service users before being served. The chef manager also stated that when required the home could supply Kosher and Hal-al meals from specialist suppliers. The inspector was invited to have lunch with the service users and chose the fish option, which was well presented and very enjoyable. Service users spoken to were all very complimentary about the meals served by the home. Records of a range of health and safety records including temperatures of the fridge and freezers and the temperatures of the meals when cooked and when served were checked and were satisfactory. Wellington Park Nursing Home DS0000027825.V295918.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 inspected at least once during a 12 month period. 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. Service users and their relatives can be confident that any concerns they raise with the home will be properly dealt with. Service users are also protected by a clear adult protection policy and procedures. EVIDENCE: The home has a clear complaints procedure that was also seen in the home’s statement of purpose. The home had received one complaint since the last inspection and evidence was seen that this had been dealt with effectively and promptly. The registered manager was clear about the importance of dealing with complaints effectively as part of the overall quality monitoring of the home. Service users and relatives spoken to were clear that if they raised issues or concerns with the registered manager or her staff they would be dealt with appropriately. The home has a satisfactory adult protection policy and procedure that staff were aware of. A requirement was made at the last inspection that the home must also obtain a copy of the local authority adult protection policy for the area the home is situated in. The inspector was pleased to see that this had been complied with. No allegations or disclosures of abuse had been made to the home since the last inspection. Wellington Park Nursing Home DS0000027825.V295918.R01.S.doc Version 5.2 Page 16 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, 21 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a home that is well decorated, well maintained and generally meets their needs. Some further action is needed to ensure that identified toilet facilities fully meet service users needs. The home was clean and tidy throughout creating a pleasant environment for service users, staff and visitors. EVIDENCE: The registered manager showed the inspector around the home. The building is well decorated, well maintained and generally well suited to meeting service users needs. The home has twenty three single bedrooms and two double bedrooms, all with en-suite facilities, situated on three floors. One of the double rooms accommodates two service users and the other is currently used for single occupancy. The inspector was pleased to see that a requirement made at the last inspection that all service users have access to a lockable space in their bedrooms had been complied with. There are bath and toilet Wellington Park Nursing Home DS0000027825.V295918.R01.S.doc Version 5.2 Page 17 facilities on the three floors that contain bedrooms. The home’s dining room and main lounge and an additional two toilets are situated in the basement. A passenger lift links all floors. It was noted that one bathroom had been converted into a quiet room since the last inspection after prior consultation with the Commission. During the inspection it was noted that the two adjoining toilets in the basement were in need of decoration and a requirement is made regarding this. The inspector was informed that both these toilets were too small to enable a service user in a wheelchair to be appropriately assisted to use them without the door being left open. This potentially compromised the privacy and dignity of service users when this occurred. These two toilets are in regular use as they are the only ones on this floor that also contains the home’s main lounge and dining facilities. A requirement is made that suitable arrangements are put in place to ensure that the privacy and dignity of all service users who use these toilets are maintained at all times. A good practice recommendation is also made that the registered provider explores the feasibility of removing the adjoining wall between these two toilets and converting them to make one fully accessible toilet that would more fully meet the service users needs. The home has satisfactory laundry facilities that were seen. The member of staff who operates these facilities explained to the inspector the way that laundry was dealt with to minimise loss or damage to service users clothing. Service users spoken to indicated that this service worked well for them. The home also had satisfactory infection control policies and procedures that staff spoken to were familiar with. The home was clean and tidy throughout during the inspection. Wellington Park Nursing Home DS0000027825.V295918.R01.S.doc Version 5.2 Page 18 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, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a staff team with sufficient numbers to effectively support the service users accommodated. Service users benefit from staff having access to relevant qualification training. Service users are protected by the home’s recruitment policy although an identified improvement is needed to enhance this. Staff have access to a wide range of training to assist them in meeting service users needs although a clearer monitoring mechanism is needed to ensure this is up to date and to prioritise planning of future training in the home. EVIDENCE: The staff rota for the home was inspected and was satisfactory with staff on duty during the inspection matching those recorded on the rota. Staffing levels in the home remain as follows: two qualified nurses and six care staff on duty on the early shift; two qualified nurses and four care staff on duty on the late shift and one qualified nurse and three care staff on duty at night. In addition the home employs a satisfactory range of kitchen, laundry and domestic staff. The home continues to meet the national minimum standard that at least 50 of care staff are qualified to national vocational qualification (NVQ) level 2 in care. The home was employing fifteen full time care staff at the time of the inspection. The registered manager informed the inspector that nine of these had obtained this qualification and another two were currently in the process of Wellington Park Nursing Home DS0000027825.V295918.R01.S.doc Version 5.2 Page 19 obtaining it. Evidence to support this was gathered from some staff files seen and from discussion with some care staff. The inspector was informed that eight new staff had been recruited since the last inspection and staff files for four of these were inspected at random, including the file for one qualified nurse. Evidence from these files indicated that the home was operating an effective recruitment procedure. All the files inspected included: satisfactory proof of identity; two files contained a satisfactory criminal records bureau (CRB) check that included a protection of vulnerable adults (POVA) clearance and the other two, for staff that had been employed immediately prior to the inspection, included the required POVA clearance while the full CRB clearance was being processed; the file for the qualified nurse employed showed verification of their qualification and registration with their professional body, the nursing and midwifes council; all four files included two references including one from staff members last employer. It was noted that two of the last employer references were not supplied on headed paper or evidence seen that they were otherwise checked to ensure that they were from the last employer. A requirement is made that all last employer references are verified to ensure they are genuine. The inspector was informed that the provider organisation supports the home run an effective training programme for staff and a list of training provided over the past twelve months was seen. This was comprehensive and included induction, training, core skills training and a range of other more specialist training. However, at the inspection there was not a list of training or other documentation available to evidence when individual staff members had received training and to be able to monitor when refresher training in core skills would need to be provided. A requirement is made regarding this to enable the home to effectively measure what training an individual staff member has undertaken and what their future training requirements are. Individual staff members spoken to independently confirmed that they had undertaken a range of different training courses in the past year. Wellington Park Nursing Home DS0000027825.V295918.R01.S.doc Version 5.2 Page 20 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, 33, 35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from the home being run by a competent manager. Service users and other stakeholders views are actively sought to assist develop the quality of care the home offers. Service users are protected by effective procedures to safeguard their financial interests. Staff need to receive regular supervision to assist them meet service users needs and to assist their own development. The home has clear health and safety policies in place to protect service users and others that work or visit the home although attention is still needed in an identified area to maximise this protection. EVIDENCE: The registered manager is a qualified nurse with a wide range of professional and management experience in both health and social care settings. She Wellington Park Nursing Home DS0000027825.V295918.R01.S.doc Version 5.2 Page 21 liaises effectively with the Commission in an appropriate and ongoing manner. The inspector has been impressed with her judgement and actions over several complex issues relating to the home since the last inspection. The home has an effective quality assurance system. Satisfaction surveys are sent out on a regular basis to service users and relatives and an analysis of the results of the last one, undertaken in February 2006, was seen displayed in the entrance to the lounge. The home holds regular meetings for relatives and a relative spoken to indicated that they found these helpful. The provider organisation also undertakes monthly unannounced visits to the home to audit the quality of care and reports of these visits are sent to the Commission on a regular basis. The registered manager and an administrator spoken to confirmed that the home does not take responsibility for service user finances and that these are dealt with by service users themselves, their relatives or other representatives. This includes service users personal allowances with the home paying for additional items such as hairdressing and newspapers and then sending out monthly invoices regarding these. A number of staff spoken to independently stated that they received individual supervision from a senior member of staff, which they felt was useful. However, not all staff were receiving this supervision every two months as required in the national minimum standards and a requirement is made regarding this. At the last inspection the inspector spoke with some staff from black and ethnic minority communities and with some white service users and relatives. The inspector’s judgement from this was that some staff could be vulnerable to institutional racism from a small minority of service users and relatives. A requirement was made that the home ensures that its equalities policy was reviewed and any potential barriers to communication between staff and relatives were sensitively addressed. Staff from black and ethnic minority communities spoken to at this inspection felt satisfactorily supported while working at the home. A range of satisfactory health and safety documentation was inspected. This included: a gas safety certificate, portable appliances inspection certificate, evidence that the home’s water system is regularly inspected to reduce the risk of legionella, servicing of fire fighting equipment, servicing of the lift, servicing of the hoists used for moving and handling and a range of weekly and monthly checks carried out by the handy person including testing of hot water temperatures. At the last inspection a requirement was made that all fire doors are kept closed unless held open by an approved electro-magnetic device or unless specific agreement is reached with the fire officer following a specific risk assessment, to meet assessed needs for identified service users. The inspector was pleased to see that nine additional electro-magnetic devices had been Wellington Park Nursing Home DS0000027825.V295918.R01.S.doc Version 5.2 Page 22 fitted to fire doors including service user’s bedroom doors. However, during the inspection it was noted that a fire door to the lounge was propped open and had not been fitted with an electro-magnetic device. The requirement is restated for this identified door. At the last inspection a requirement was also made that the home must ensure that a full and current fire risk assessment and fire plan is available for inspection and that the fire officer is formally consulted and approves these. The inspector was disappointed to find that this had not been complied with and the requirement is restated. Wellington Park Nursing Home DS0000027825.V295918.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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 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 3 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Wellington Park Nursing Home DS0000027825.V295918.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14(1&2) Requirement Timescale for action 31/07/06 2 OP7 15(1) 3 OP8 13(1) 4 OP9 13(2) The registered persons must ensure that a person competent to do so reassesses three identified service users. If dementia is now assessed as the main reason for the person being accommodated, the home must then apply to the Commission for a variation to its conditions of registration for each of these service users if it wishes to continue to care for them. The registered persons must 07/07/06 ensure that the care plan for one identified service user is updated to give clear guidance to staff on how to address their rapidly changing needs. The registered persons must 31/07/06 ensure that a separate record of appointments with healthcare professionals is kept on each service user’s file to assist monitor their ongoing healthcare needs. The registered persons must 31/07/06 ensure that prescribed medication for service users is kept in and dispensed from its DS0000027825.V295918.R01.S.doc Version 5.2 Wellington Park Nursing Home Page 25 5 OP9 13(2) 6 7 OP21 OP10 OP21 23(2) 12(4), 23(2) 8 OP29 19(5) 9 OP30 18(1) 10 OP36 18(2) 11 OP38 23(4) 12 OP38 23(4) original packaging to avoid the danger of mishandling unless otherwise directed by a person competent to make that decision. The registered manager must ensure that the temperature of the area where medication is stored is maintained at 25ºC or below and the medication refrigerator is maintained between 2-8ºC (previous timescale of 17/12/05 not met). The registered persons must ensure that two identified toilets are redecorated. The registered persons must ensure that suitable arrangements are put in place to ensure that the privacy and dignity of all service users who use two identified toilets are maintained at all times. The registered persons must ensure that when recruiting staff last employer references are verified to ensure they are genuine. The registered persons must ensure that training records for individual staff members are kept and available for inspection to effectively measure what training each staff member has undertaken and what their future training requirements are. The registered persons must ensure that staff receive formal and recorded supervision at least once every two months. The registered persons must ensure that a full and current fire risk assessment and fire plan is available for the home and that the fire officer is formally consulted on these (previous timescale of 31/01/06 not met). The registered persons must DS0000027825.V295918.R01.S.doc 31/07/06 31/08/06 07/07/06 31/07/06 31/07/06 31/07/06 31/07/06 31/07/06 Page 26 Wellington Park Nursing Home Version 5.2 ensure that the identified fire door to the lounge is kept closed unless held open by an approved electro-magnetic device (previous timescale of 31/01/06 not met). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The home should explore the feasibility of removing the adjoining wall between two identified toilets and converting them to make one fully accessible toilet that would more fully meet the service users needs. Wellington Park Nursing Home DS0000027825.V295918.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Park Nursing Home DS0000027825.V295918.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!